Limited coverage drugs – abatacept for the treatment of Rheumatoid Arthritis

Last updated on March 15, 2023

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Generic name	abatacept
Strength	250 mg/15 mL, 125 mg/mL
Form	intravenous infusion vial, subcutaneous injection solution

Special Authority criteria	Approval period
For the treatment of rheumatoid arthritis (RA) according to established criteria requirements described in the below Special Authority request forms 5345 (Initial/Switch) and 5354 (Renewal). Coverage of abatacept for the treatment of RA is only available when abatacept is prescribed by a rheumatologist.	1 year

Special Authority criteria

Approval period

For the treatment of rheumatoid arthritis (RA) according to established criteria requirements described in the below Special Authority request forms 5345 (Initial/Switch) and 5354 (Renewal).

Coverage of abatacept for the treatment of RA is only available when abatacept is prescribed by a rheumatologist.

1 year

Practitioner exemptions

None

Special notes

The maximum covered allowable supply of abatacept is 28 days per fill

Special Authority request form(s)

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Limited coverage drugs – abatacept for the treatment of Rheumatoid Arthritis

Practitioner exemptions

Special notes

Special Authority request form(s)