Canakinumab (Ilaris)

This policy covers canakinumab (Ilaris) only for FDA‑approved indications—CAPS (≥4 years), TRAPS, HIDS/MKD, FMF, and active sJIA (≥2 years)—and excludes off‑label use. Approvals require documentation of diagnosis, age, specified prescriber specialty/consultation, weight‑based dosing and max limits, sJIA must meet prior‑therapy criteria (trial of ≥2 biologics or specific poor‑prognosis/Actemra/Kineret exceptions), initial time‑limited approval (CAPS/sJIA 3 months; FMF/TRAPS/HIDS‑MKD 4 months) and 12‑month renewals only with documented clinical response.

"Cryopyrin-Associated Periodic Syndromes (CAPS), in patients 4 years of age and older"

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