Health Net
Arcalyst (rilonacept)
Drugs for Pain and Fever : Arthritis and Pain Drugs
  • Prior Authorization: Cryopyrin-Associated Periodic Syndromes (CAPS):
    Age Requirement: >= 12
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Recurrent Pericarditis :
    Documented Diagnosis: Yes
    Age Requirement: >= 12
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Step Therapy: Recurrent Pericarditis :
    ST Multiple Generics

  • Cryopyrin-Associated Periodic Syndromes (CAPS):
    Age Requirement: >= 12
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: No
    Medical Test Required: No
    Specialist Type(s): Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: >= 6 month(s)

    Recurrent Pericarditis :
    Age Requirement: >= 12
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Cardiologist;Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: >= 6 month(s)

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