Arcalyst® Prior Authorization CriteriaAracalyst1Arcalyst (rilonacept) is an interleukin-1(IL-1) blocker indicated for the treatment of Cryopyrin-Associated Periodic Syndromes (CAPS) including Familial Cold Autoinflammatory Syndrome (FCAS) and Muckle-Wells Syndrome (MWS) in adults and children 12 ...
PRIOR AUTHORIZATION CRITERIA FOR APPROVAL Solodyn® (minocycline extended-release) Initial and Renewal Evaluation 1. Is the patient 12 years of age or older? If yes, continue to 2. If no, deny. 2. Does the patient have a diagnosis of inflammatory lesions of non-nodular moderate to severe ...