Preferred Adalimumab Products (Revised)

By December 15, 2025: Billing and clinical teams must implement prior authorization workflow for all adalimumab products (Humira, adalimumab-adbm, adalimumab-adaz) across all formulations (pens, syringes, starter kits). Update billing software to flag requests for the following indications and require PA documentation: (1) Rheumatoid Arthritis - verify diagnosis severity, age ≥18, and prior DMARD trial/intolerance; (2) Juvenile Idiopathic Arthritis - verify polyarticular diagnosis, age ≥2, and prior DMARD trial/intolerance; (3) Plaque Psoriasis - verify moderate-to-severe diagnosis, age ≥18, and prior oral systemic therapy; (4) Ankylosing Spondylitis - verify active diagnosis, age ≥18, and NSAID trial/intolerance; (5) Crohn's Disease - verify moderate-to-severe diagnosis, age ≥6; (6) Psoriatic Arthritis - verify active diagnosis, age ≥18; (7) Ulcerative Colitis - verify moderate-to-severe diagnosis, age ≥5; (8) Hidradenitis Suppurativa - verify moderate-to-severe diagnosis, age ≥12; (9) Uveitis - verify non-infectious intermediate/posterior/pan-uveitis diagnosis, age ≥2, and prior steroid/anti-metabolite/calcineurin inhibitor trial/intolerance; (10) Behcet's Disease oral ulcers - verify diagnosis, age ≥18, and prior treatment with ≥2 of: topical corticosteroid, azathioprine, colchicine, or cyclosporin. Providers must submit prior authorization requests with diagnosis documentation, patient age verification, and evidence of prior therapy/contraindication/intolerance. Billing team must communicate PA requirements to all prescribing providers. Update encounter forms and EMR templates to include indication-specific clinical criteria checklist. Claims submitted without required prior authorization will be denied. Ensure staff review the boxed warnings regarding serious infections (TB screening required), malignancies, hepatitis B reactivation, and demyelinating disease before authorizing therapy.