Rheumatology Specialty Medications

Each medication is approved for its own conditions, ages and treatment history, and the rheumatologist determines which is appropriate.

• Rheumatoid arthritis: intravenously, Remicade and its biosimilars Inflectra (infliximab-dyyb), Avsola (infliximab-axxq) and Renflexis (infliximab-abda), Simponi Aria, Orencia, Actemra and its biosimilar Tyenne (tocilizumab-aazg), and Rituxan and its biosimilar Ruxience (rituximab-pvvr); by injection, Humira (adalimumab), Enbrel (etanercept), Cimzia (certolizumab pegol), Kevzara (sarilumab), Simponi, Orencia, Actemra and methotrexate; by mouth, Rinvoq (upadacitinib) and Xeljanz (tofacitinib), after TNF blocker treatment.
• Psoriatic arthritis: Remicade, Simponi Aria and Orencia intravenously; Humira, Enbrel, Cimzia, Simponi, Cosentyx (secukinumab), Taltz (ixekizumab) and Bimzelx (bimekizumab-bkzx) by injection; Rinvoq, Xeljanz and Otezla (apremilast) by mouth.
• Ankylosing spondylitis: Remicade and Simponi Aria intravenously; Humira, Enbrel, Cimzia, Simponi, Cosentyx, Taltz and Bimzelx by injection; Rinvoq and Xeljanz by mouth. Cimzia, Cosentyx, Taltz, Bimzelx and Rinvoq are also approved for non-radiographic axial spondyloarthritis.
• Juvenile idiopathic arthritis: for the polyarticular form, Simponi Aria, Orencia, Actemra, Humira, Enbrel, Cimzia, Kevzara, Rinvoq, Xeljanz and methotrexate; for the systemic form, Actemra and Ilaris (canakinumab); for enthesitis-related arthritis, Cosentyx.
• Giant cell arteritis and polymyalgia rheumatica: Actemra and Rinvoq for giant cell arteritis; Kevzara for polymyalgia rheumatica.
• Granulomatosis with polyangiitis and microscopic polyangiitis (ANCA vasculitis): Rituxan, with glucocorticoids.
• Systemic sclerosis-associated interstitial lung disease: Actemra, by subcutaneous injection only.
• Systemic lupus erythematosus and lupus nephritis: Benlysta (belimumab) for both and Saphnelo (anifrolumab-fnia) for lupus, intravenously or by subcutaneous injection, with standard lupus treatment.
• Gout: Krystexxa (pegloticase), intravenously, for chronic gout when uric acid-lowering tablets did not control it or cannot be taken; Ilaris for gout flares when NSAIDs, colchicine and repeated steroid courses are not suitable.
• Periodic fever syndromes and Still's disease: Ilaris, for cryopyrin-associated periodic syndromes (CAPS), TRAPS, HIDS/MKD, familial Mediterranean fever and Still's disease.
• Oral ulcers of Behçet's disease: Otezla.
• Osteoporosis after menopause: Reclast (zoledronic acid) and ibandronate, given into a vein; Prolia (denosumab) and its biosimilar Jubbonti (denosumab-bbdz), Evenity (romosozumab-aqqg) and Forteo (teriparatide), by subcutaneous injection. Reclast is also approved to prevent it.
• Osteoporosis in men and osteoporosis from long-term glucocorticoids: Reclast, Prolia and Forteo.
• Paget's disease of bone: Reclast.

When the rheumatologist approves home therapy, MedRx Infusion sends a skilled, trusted and licensed nurse from an accredited nursing agency to give infusions such as Remicade, Orencia, Actemra, Rituxan, Benlysta or Reclast, and to monitor vital signs and adverse reactions until the infusion is complete. Practices that infuse in the office can have the medication delivered there. See home infusion nursing.

Self-injected medications such as Humira, Enbrel and Forteo are used at home by the patient or a caregiver once trained. Some labels limit where, or by whom, a medication is given:

• Krystexxa is given in a healthcare setting by providers prepared to manage serious allergic reactions, as its label requires. MedRx Infusion dispenses it for the setting where it is given.
• Cosentyx's intravenous form is given only by a healthcare professional in a healthcare setting.
• Prolia, Evenity, Ilaris and methotrexate injection are given by a healthcare professional. The prescriber determines where.

1. For arthritis, lupus, vasculitis and gout medications, the practice completes the Rheumatology referral form (PDF), whose two pages list medications from A to R and from R to Z. For osteoporosis, it uses the Osteoporosis referral form (PDF). Both can be completed online on the Quick Referral page and printed.
2. The office faxes the form to (844) 671-2601, together with recent clinical notes and laboratory results, the ICD-10 diagnosis code and the treatments already tried; the rheumatology form also asks for the date of a negative TB test. For a medication the form does not print, the office can call (844) 671-2600.
3. The prescriber marks where the medication is to be given (the patient's home, the prescriber's office or another site) and can have MedRx hold the shipment until notified.
4. MedRx's intake team verifies benefits and obtains any prior authorization the plan requires.
5. The order, with an anaphylaxis kit, diluents, flushes and supplies as needed, is delivered to the patient's door at no charge. Next-day delivery is available; timing varies by location. A MedRx pharmacist is available 24 hours a day, 7 days a week.

Plans often require prior authorization for these medications. Several labels apply after earlier treatment did not work well enough, and the referral form records the medications already tried. MedRx's intake team confirms benefits before the first delivery.

Where cost is a barrier, MedRx helps the patient look for and apply to copay assistance, grant programs and other financial aid, including manufacturers' programs such as Orencia On Call, Amgen SupportPlus (Enbrel, Otezla, Prolia and Evenity), J&J withMe (Remicade and Simponi), Together with Benlysta and Genentech's programs for Actemra and Rituxan. Each medication's page names its program.

• Infusions for arthritis and vasculitis: Remicade, Simponi, Orencia, Actemra and Rituxan.
• Injections and tablets for arthritis: Humira, Enbrel, Cimzia, Kevzara, Cosentyx, Taltz, Bimzelx, Rinvoq, Xeljanz, Otezla and Methotrexate.
• Lupus: Benlysta and Saphnelo.
• Gout and periodic fever syndromes: Krystexxa and Ilaris.
• Osteoporosis: Prolia, Evenity, Forteo, Zoledronic Acid and Ibandronate.

Each has its own page: what it is approved for, how it is given, and how to start. See every medication we fill.