Baricitinib (Olumiant®)

SELF ADMINISTRATION

Indications for Prior Authorization:

  • Treatment of adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response to one or more TNF antagonist therapies

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

  • Patient is 18 years of age and older, AND
  • Patient has a diagnosis of moderately to severely active rheumatoid arthritis, AND
  • Prescribed by or in consultation with a rheumatologist, AND
  • Patients must try and fail at least two of the following preferred agents: Xeljanz/XR, Actemra SC, Enbrel, or Humira
    • Xeljanz/XR must be one of the two preferred agents that have been tried and failed
    • Please note: A trial of either or both Xeljanz products (Xeljanz and Xeljanz XR) collectively counts as one product, AND
  • Olumiant will not be used in combination with other JAK inhibitors, biologic DMARDs, or with potent immunosuppressants such as azathioprine and cyclosporine, AND
  • Patient will not receive live vaccines, AND
  • Patient will not use in combination with strong OAT3 inhibitors (e.g. probenecid)

Dosing:

  • 2 mg once daily
  • Severe hepatic impairment: use is not recommended
  • Moderate or severe hepatic impairment: use is not recommended

Approval:

  • Initial: 3 months
  • Continuation: 1 year if chart note documents patient response to therapy

Risk of Tuberculosis:

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

Last review date: May 29, 2019