Orencia® (Abatacept) Injection for Intravenous Infusion – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers IV Orencia (abatacept) for PJIA, RA, PsA, chronic GVHD, prophylaxis of acute GVHD in HSCT recipients, and severe immune checkpoint inhibitor–related cardiac toxicities, and considers it not medically necessary for multiple sclerosis, systemic lupus erythematosus, and Behçet’s-associated uveitis. Coverage requires diagnosis-appropriate FDA‑labeled dosing, no concomitant targeted immunomodulators, specialist prescribing/consultation as specified, documentation of prior DMARD or targeted therapy trials where required and of positive clinical response for continuation, with initial authorizations generally limited to ≤12 months (and ≤4 doses for aGVHD prophylaxis and checkpoint-toxicity indications) plus specific criteria for aGVHD (age ≥2, matched/1‑allele mismatched donor, use with calcineurin inhibitor + methotrexate) and for checkpoint toxicities (severe G3–G4 cardiac events, no improvement after 24 h of pulse steroids, and failure/contraindication to infliximab).