roflumilast cream — Blue Cross Blue Shield of Kansas

Initial criteria

• Patient has a diagnosis of plaque psoriasis
• AND Patient's affected body surface area (BSA) is ≤ 20%
• AND ONE of the following:
• • Patient has tried and had an inadequate response to a topical corticosteroid used in the treatment of plaque psoriasis after at least a 2-week duration of therapy OR
• • Patient has an intolerance or hypersensitivity to therapy with a topical corticosteroid used in the treatment of plaque psoriasis OR
• • Patient has an FDA labeled contraindication to ALL topical corticosteroids used in the treatment of plaque psoriasis
• AND ONE of the following:
• • Patient has tried and had an inadequate response to another topical psoriasis agent with a different mechanism of action (e.g., vitamin D analogs, calcineurin inhibitors, tazarotene)