Skip to content
The Policy VaultThe Policy Vault

Spevigo (spesolimab-sbzo) — Blue Cross Blue Shield of Alabama

generalized pustular psoriasis (GPP)

Initial criteria

  • ONE of the following:
  • • The requested agent is eligible for continuation of therapy AND ONE of the following:
  • – The patient has been treated with the requested agent (starting on samples is not approvable) within the past 90 days OR
  • – The prescriber states the patient has been treated with the requested agent (starting on samples is not approvable) within the past 90 days AND is at risk if therapy is changed
  • OR BOTH of the following:
  • • ONE of the following:
  • – The patient has a diagnosis of generalized pustular psoriasis (GPP) AND ALL of the following:
  • • The patient has moderate to severe GPP AND
  • • The patient has a history of 2 or more flares AND
  • • The patient is NOT currently experiencing an acute flare
  • – OR the patient has another FDA labeled indication for the requested agent
  • • If the patient has an FDA labeled indication, then ONE of the following:
  • – The patient’s age is within FDA labeling for the requested indication for the requested agent OR
  • – There is support for using the requested agent for the patient’s age
  • • If the patient has a diagnosis of GPP, then the patient weighs ≥ 40 kg
  • • The prescriber is a specialist in the area of the patient’s diagnosis (e.g., dermatologist) or has consulted with a specialist in the area of the patient’s diagnosis
  • • ONE of the following:
  • – The patient does NOT have active or latent tuberculosis (TB) OR
  • – The patient has latent tuberculosis (TB) and has begun or completed therapy for latent TB prior to initiating the requested agent
  • • ONE of the following:
  • – 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 the use with another immunomodulatory agent