Abrilada — CareFirst (Caremark)

Initial criteria

• Adult members who have previously received a biologic or targeted synthetic drug (e.g., Sotyktu, Otezla) indicated for moderate to severe plaque psoriasis OR
• Adult members with moderate to severe plaque psoriasis when any of the following is met: crucial body areas (e.g., hands, feet, face, neck, scalp, genitals/groin, intertriginous areas) are affected; ≥10% body surface area affected; ≥3% BSA affected AND member had inadequate response/intolerance to phototherapy (e.g., UVB, PUVA) or to pharmacologic treatment with methotrexate, cyclosporine, or acitretin; OR member has a clinical reason to avoid methotrexate, cyclosporine, and acitretin

Reauthorization criteria

• Adult members (including new members) using the medication for moderate to severe plaque psoriasis who achieve or maintain a positive clinical response as evidenced by reduction in body surface area affected from baseline OR improvement in signs and symptoms (e.g., itching, redness, flaking, scaling, burning, cracking, pain)

Approval duration

12 months