Otezla (apremilast) — Blue Cross Blue Shield of Alabama

Initial criteria

• The patient will NOT be using the requested agent in combination with another immunomodulatory agent (e.g., TNF inhibitors, JAK inhibitors, IL-4 inhibitors) OR The patient will be using the requested agent in combination with another immunomodulatory agent AND BOTH of the following: The prescribing information for the requested agent does NOT limit use with another immunomodulatory agent AND There is support for the use of combination therapy (submitted copy of clinical trials, phase III studies, or guidelines required)
• ONE of the following: The patient has a diagnosis of mild severity plaque psoriasis OR The prescriber is a specialist in the area of the patient’s diagnosis (e.g., dermatologist, rheumatologist), or the prescriber has consulted with a specialist in the area of the patient’s diagnosis
• The patient does NOT have any FDA labeled contraindications to the requested agent

Approval duration

12 months