May 24, 2019

VDP will revise the Cytokine and CAM Antagonists clinical prior authorization on June 25. The updates are the result of the following changes in the drug class:

  • The clinical prior authorization criteria for Olumiant was approved by the Drug Utilization Review Board on Jan. 25.
  • In March, the FDA approved Cimzia for treatment of adults with non-radiographic axial spondyloarthritis with objective signs of inflammation.
  • The FDA also approved Ilumya in March for treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy.

Updates to the clinical prior authorization criteria include:

  • Olumiant: people 18 years and older with diagnosis of rheumatoid arthritis who failed prior TNF-blocker treatment, and do not have the drug-drug or drug-disease contraindications documented on the product package insert.
  • Cimzia: expanded indication for treatment of non-radiographic axial spondyloarthritis with objective signs of inflammation.
  • Ilumya: people 18 years and older with diagnosis of moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy.

This prior authorization remains optional for Medicaid managed care. The Pharmacy Clinical Prior Authorization Assistance Chart (PDF) shows the prior authorization each managed care organization (MCO) uses and how those authorizations relate to the authorizations used for traditional Medicaid claim processing. This chart is updated quarterly. Providers can also refer to the MCO Resources for links to each MCO's list of clinical prior authorizations.