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Otezla (apremilast) — Blue Cross Blue Shield of Illinois

Behçet’s disease (BD)

Initial criteria

  • Patient meets one of the following: (1) Has failed treatment with at least one conventional agent (e.g., azathioprine) used in BD; OR (2) Has an intolerance or hypersensitivity to one conventional agent used in BD; OR (3) Has an FDA labeled contraindication to all conventional agents used in BD; OR (4) Has medication history indicating use of another biologic immunomodulator agent that is FDA labeled or supported in compendia for BD.
  • If the patient has an FDA labeled indication, then one of the following applies: (A) Age is within FDA labeling for the indication; OR (B) There is support for using the requested agent for patient’s age for that indication; OR (C) Patient has another indication supported in compendia for the agent and route.
  • One of the following: (A) The patient will NOT be using the requested agent with another immunomodulatory agent (e.g., TNF inhibitors, JAK inhibitors, IL-4 inhibitors); OR (B) The patient will be using the requested agent with another immunomodulatory agent AND both: (1) the prescribing information does not limit such combination; AND (2) support for combination therapy provided (clinical trials, phase III studies, or guidelines).
  • One of the following: (A) Patient has diagnosis of mild severity plaque psoriasis; OR (B) Prescriber is a specialist (e.g., dermatologist, rheumatologist) or has consulted one.
  • Patient does NOT have any FDA labeled contraindications to the requested agent.

Reauthorization criteria

  • Patient previously approved for the requested agent through the plan’s Prior Authorization process.
  • Patient has had clinical benefit with the requested agent.
  • One of the following: (A) Not using requested agent in combination with another immunomodulatory agent (e.g., TNF inhibitors, JAK inhibitors, IL-4 inhibitors); OR (B) Using with another immunomodulatory agent AND both: (1) prescribing information does not limit such combination; AND (2) support for combination therapy provided (clinical trials, phase III studies, or guidelines).
  • One of the following: (A) Patient has mild severity plaque psoriasis; OR (B) Prescriber is a specialist (dermatologist, rheumatologist) or has consulted with one.
  • Patient has no FDA labeled contraindications to the requested agent.

Approval duration

12 months