Otezla (apremilast) — Blue Cross Blue Shield of Illinois

Initial criteria

• Member resides in Ohio AND plan is Fully Insured or HIM Shop (SG).
• Patient does NOT have any FDA labeled contraindications to the requested agent.
• One of the following: (1) Patient has another FDA labeled indication for requested agent and route; OR (2) Patient has another compendia supported indication for requested agent and route; OR (3) Prescriber has submitted two peer-reviewed journal articles (e.g., JAMA, NEJM, Lancet) supporting the proposed use(s) as generally safe and effective, with acceptable study design (randomized, double-blind, placebo-controlled).
• Non-oncology compendia allowed: DrugDex level 1, 2A, 2B; AHFS-DI supportive narrative. Oncology compendia allowed: NCCN 1 or 2A; AHFS-DI supportive; DrugDex level 1, 2A, 2B; Clinical Pharmacology supportive; LexiDrugs evidence level A; peer-reviewed medical literature.

Approval duration

12 months