Canakinumab (Ilaris)

Ilaris (canakinumab) is covered only for FDA‑approved indications (CAPS, TRAPS, HIDS/MKD, FMF, active sJIA ≥2 years, and adult‑onset Still’s) with indication‑ and weight‑based dosing limits (maximum 300 mg) and off‑label uses not covered. Coverage requires indication‑ and age‑specific prescribing/consultation by designated specialists, prior‑therapy criteria for sJIA/Still’s (e.g., trials of ≥2 biologics or specified agents/MAS‑poor‑prognosis pathways), time‑limited initial approvals (3 months for CAPS/sJIA/Still’s; 4 months for FMF/TRAPS/HIDS) with 12‑month renewals contingent on documented clinical response, plus documentation of diagnosis, age, specialist involvement, prior biologics, body weight, and any safety/MAS or poor‑prognosis evidence.

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