Western Health Advantage
Rinvoq (upadacitinib)
Drugs for Pain and Fever : Arthritis and Pain Drugs
  • Available through Specialty Pharmacy;
  • Quantity Limit: 30 day supply per 1 fill(s).
  • Prior Authorization: Atopic Dermatitis (Eczema):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 12
    Duration: 1 year(s)
    Reauthorization Required: Yes

    Psoriatic Arthritis (PsA):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Duration: 1 year(s)
    Reauthorization Required: Yes

    Rheumatoid Arthritis (RA), Ulcerative Colitis (UC):
    Documented Diagnosis: Yes
    Duration: 1 year(s)
    Reauthorization Required: Yes

  • Atopic Dermatitis (Eczema):
    Age Requirement: >= 12
    Duration: 1 year(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): Dermatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 year(s)
    Initial Authorization - POEM Values: N/A
    Initial Authorization - SCORAD Values: N/A
    Initial Authorization - EASI Values: N/A
    Initial Authorization - IGA Values: 3
    Initial Authorization - PGA Values: N/A
    Initial Authorization - ISGA Values: N/A
    Initial Authorization - BSA Values: N/A
    Physician Attestation for Initiation Required: No
    Step Trial Length Period: 1 month(s)
    Reauthorization Assessment Required: IGA

    Psoriatic Arthritis (PsA):
    Duration: 1 year(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): 1 of Dermatologist;Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 year(s)
    TB Test required: Yes

    Rheumatoid Arthritis (RA):
    Duration: 1 year(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 year(s)
    TB Test required: No

    Ulcerative Colitis (UC):
    Duration: 1 year(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Gastroenterologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 year(s)
    TB Test required: No

  • Step Therapy: Atopic Dermatitis (Eczema), Ulcerative Colitis (UC):
    ST Multiple Generics

    Psoriatic Arthritis (PsA):
    ST Single Generic

    Rheumatoid Arthritis (RA):
    ST Generic and Brand

  • PA Required
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