Anakinra (Kineret®)


Indications for Prior Authorization:

  • Rheumatoid Arthritis

Risk of Tuberculosis

Patients should be evaluated for latent tuberculosis infection with a TB skin test. Treatment of latent tuberculosis infection should be initiated prior to therapy with Kineret®.

Patients must meet the following criteria for the indication(s) above:

Rheumatoid Arthritis (moderate to severe)

  • Diagnosis of moderate to severe rheumatoid arthritis confirmed by chart note documentation, AND
  • Diagnosis confirmed by a Rheumatologist (the prescribing MD does not have to be a Rheumatologist), AND
  • Inadequate response to one or more Disease-Modifying Anti-Rheumatic Drugs (DMARDs): Auranofin, Azathioprine, Gold sodium thiomalate, hydroxychloroquine, methotrexate, D-penicillamine, sulfasalazine OR has a medical reason why Methotrexate, Hydroxychloroquine, and Sulfasalazine cannot be used, AND
  • Inadequate response or intolerable side effects to at least two preferred biologic agents: Humira®, Cimzia®, Simponi®, Xeljanz/XR®, Rinvoq®AND
  • Inadequate response to BOTH Actemra® and Orencia®AND
  • Patient meets one of the following:
    • Initiation of biologic therapy: patient has a negative tuberculosis test result (e.g. TB skin test, Quantiferon TB Gold test, or chest x-ray) prior to therapy initiation as evidenced by a recent TB test result OR
    • Continuation of therapy or switching biologic therapies: patient had a negative TB test result within the past year (as evidenced by a current TB test result)


Rheumatoid Arthritis

  • 100 mg SubQ daily (every other day administration may be considered for RA patients who have severe renal insufficiency or end-stage renal disease (defined as creatinine clearance < 30 mL/min, as estimated from serum creatinine levels))


  • Initial: 3 months to assess the patient’s response
  • Continuation: 1 year with specialist chart notes documenting a clinical response to therapy and current TB (tuberculosis) test results


    Last review date: February 18, 2020

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