Ilaris® (Canakinumab) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Ilaris (canakinumab) for FDA‑labeled indications — CAPS (FCAS, MWS) (≥4 years), TRAPS, HIDS/MKD, FMF, active Still’s disease (AOSD/SJIA, ≥2 years), and adult gout flares — and excludes use for cardiovascular disease; dosing must follow FDA labeling and age limits. Coverage requires specialist diagnosis/consultation (rheumatologist or immunologist), required prior therapy trials or documented intolerance/contraindication (e.g., colchicine for FMF; colchicine and NSAIDs and ineligibility for systemic corticosteroids for gout flares), documentation of positive clinical response for reauthorization, generally ≤12‑month authorizations for chronic indications (one dose/12 weeks for gout flares), and avoidance of listed combination targeted immunomodulators for AOSD/SJIA.

"Cryopyrin-associated periodic syndromes (CAPS), including familial cold autoinflammatory syndrome (FCAS) and Muckle-Wells syndrome (MWS)."