Abatacept (Orencia)

Orencia (abatacept) is covered only for FDA‑approved indications—adult rheumatoid arthritis, adult psoriatic arthritis, and polyarticular juvenile idiopathic arthritis (≥2 years)—and off‑label uses are excluded. Coverage requires indication‑specific prior therapy or specialist involvement (e.g., documented 3‑month trial of a biologic or conventional sDMARD for RA, rheumatologist/dermatologist prescribing or consultation for PsA/JIA as specified), age/weight‑based dosing limits, documentation of diagnosis/weight, initial approval for 3 months and documented clinical response for 12‑month renewals.

"Orencia is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moder..."

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