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Eucrisa (crisaborole ointment) — Blue Cross Blue Shield of Illinois

atopic dermatitis

Preferred products

  • tacrolimus ointment

Initial criteria

  • ONE of the following must be met:
  • 1. The requested agent is for use on the face (including eyelids), neck, or skin folds (e.g., groin, armpit/under arm); OR
  • 2. The requested agent is eligible for continuation of therapy AND 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 has changed; OR
  • 3. The prescriber states the patient is currently being treated with a requested agent AND the patient is currently stable on the requested agent [chart notes required]; OR
  • 4. The patient has tried and had an inadequate response to ONE topical corticosteroid or topical corticosteroid combination preparation [chart notes required]; OR
  • 5. ONE topical corticosteroid or topical corticosteroid combination preparation was discontinued due to lack of efficacy, diminished effect, or an adverse event [chart notes required]; OR
  • 6. The patient has intolerance or hypersensitivity to ONE topical corticosteroid or topical corticosteroid combination preparation [chart notes required]; OR
  • 7. The patient has an FDA-labeled contraindication to ALL topical corticosteroids AND all topical corticosteroid combination preparations [chart notes required]; OR
  • 8. ONE topical corticosteroid or topical corticosteroid combination preparation is expected to be ineffective or cause a significant barrier, worsen a comorbid condition, decrease functional ability, or cause adverse reaction [chart notes required]; OR
  • 9. ONE topical corticosteroid or topical corticosteroid combination preparation is not in the best interest of the patient based on medical necessity [chart notes required]; OR
  • 10. The patient has tried another prescription drug in the same pharmacologic class or with the same mechanism of action as ONE topical corticosteroid or topical corticosteroid combination preparation and that drug was discontinued due to lack of efficacy, diminished effect, or adverse event [chart notes required].

Reauthorization criteria

  • Continuation of therapy is eligible when the prescriber states the patient has been treated with the requested agent within the past 90 days and is at risk if therapy has changed OR the prescriber confirms the patient is currently stable on therapy.

Approval duration

12 months