apremilast — CareFirst (Caremark)

Plaque psoriasis (PsO)

Initial criteria

Member age ≥ 6 years
Member has previously received a biologic or targeted synthetic drug (e.g., Sotyktu) indicated for treatment of plaque psoriasis OR any of the following:
Member has had an inadequate response or intolerance to ONE of the following: phototherapy (UVB, PUVA) OR topical therapies (medium or higher potency topical corticosteroids, calcineurin inhibitors, vitamin D analogs)
Member has a contraindication or clinical reason to avoid BOTH phototherapy and topical therapies
Member has had an inadequate response or intolerance to ONE of the following medications: methotrexate, cyclosporine, or acitretin
Member has a clinical reason to avoid pharmacological treatment with ALL of the following: methotrexate, cyclosporine, and acitretin
Medication not used concomitantly with any other biologic drug or targeted synthetic drug for the same indication
Prescribed by or in consultation with a dermatologist

Member age ≥ 6 years
Member achieves or maintains a positive clinical response as evidenced by low disease activity or improvement in signs and symptoms such as reduction in body surface area affected or improvement in itching, redness, flaking, scaling, burning, cracking, or pain

12 months