Abatacept

This policy covers abatacept (Orencia) for treatment of moderately to severely active rheumatoid arthritis and psoriatic arthritis in adults, polyarticular juvenile idiopathic arthritis in patients ≥6 years, and prophylaxis of acute graft‑versus‑host disease in HSCT recipients ≥2 years (matched or single‑allele‑mismatched unrelated donors) when use, dose, frequency, and duration align with FDA labeling or other authoritative compendia. Coverage requires prior inadequate response to one or more nonbiologic or biologic DMARDs for RA/PsA/JIA, mandates concurrent calcineurin inhibitor plus methotrexate for aGVHD, prohibits concomitant use with JAK inhibitors or other biologic DMARDs, is limited to HCSC members in Ohio per the member’s benefit plan, and excludes oncologic and other unproven indications.

"Therapies are covered when proven effective for the relevant diagnosis or procedure per generally accepted standards of practice."