adalimumab-adaz — CareFirst (Caremark)

Initial criteria

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

Reauthorization criteria

• Adult member (including new members) using the medication for moderate to severe plaque psoriasis with positive clinical response evidenced by low disease activity or improvement in signs and symptoms when either of: reduction in BSA affected from baseline; improvement in signs/symptoms (itching, redness, flaking, scaling, burning, cracking, pain)

Approval duration

12 months