Ilaris® (canakinumab)

Ilaris (canakinumab) is covered only for its FDA‑approved indications (CAPS, TRAPS, HIDS/MKD, FMF, sJIA, adult‑onset Still’s disease, and gout flares) and is not covered for non‑FDA indications. Coverage requires indication‑specific criteria including age limits, specialist prescribing/consultation, required lab evidence (e.g., CRP ≥10 mg/L for FMF/HIDS/TRAPS), failure or trial of prior therapies (e.g., colchicine for FMF, prior biologic for sJIA/adult‑onset Still’s, NSAID/colchicine failure for gout), documentation of dosing, initial approval typically 6 months (12 months at renewal), and (except for gout) ≥6 months on therapy plus documented objective or symptomatic improvement for reauthorization.

"Cryopyrin-Associated Periodic Syndromes (CAPS) including Familial Cold Autoinflammatory Syndrome, Muckle-Wells Syndrome, and Neonatal Onset Multisystem Inflammatory Disease (NOMID) or Chronic Infan..."