Health Net
Ilaris (canakinumab (PF))
Drugs for Pain and Fever : Arthritis and Pain Drugs
  • Prior Authorization: Adult Onset Stills Disease (AOSD):
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Cryopyrin-Associated Periodic Syndromes (CAPS):
    Age Requirement: >= 4
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Gouty Arthritis:
    Documented Diagnosis: Yes
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Juvenile Idiopathic Arthritis:
    Documented Diagnosis: Yes
    Age Requirement: >= 2
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Periodic Fever Syndromes:
    Age Requirement: >= 2
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Adult Onset Stills Disease (AOSD):
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Hematologist;Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

    Cryopyrin-Associated Periodic Syndromes (CAPS):
    Age Requirement: >= 4
    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)

    Gouty Arthritis:
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Appropriate Specialist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

    Juvenile Idiopathic Arthritis:
    Age Requirement: >= 2
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Dermatologist;Gastroenterologist;Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)
    TB Test required: No

    Periodic Fever Syndromes:
    Age Requirement: >= 2
    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)

  • Step Therapy: Adult Onset Stills Disease (AOSD), Juvenile Idiopathic Arthritis, Periodic Fever Syndromes:
    ST Single Generic

    Gouty Arthritis:
    ST Multiple Generics

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