MolDX: Molecular Biomarker Testing to Guide Targeted Therapy Selection in Rheumatoid Arthritis

Coverage is limited to adult patients with confirmed moderately to severely active rheumatoid arthritis who have failed, are intolerant of, or have contraindications to at least one csDMARD and who are either b/tDMARD‑naïve or being considered for a different class due to failure/intolerance. Tests must predict response/non-response with accuracy and reproducibility superior to existing clinical data, demonstrate AV/CV/CU with peer‑reviewed evidence, be validated (algorithms in independent cohorts), and complete a MolDX Technical Assessment to be considered reasonable and necessary.

"Patient is an adult (>=18 years) with a confirmed diagnosis of moderately to severely active rheumatoid arthritis (RA)."

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