calcipotriene topical solution — CareFirst (Caremark)

Initial criteria

• The requested drug is being prescribed for the treatment of psoriasis
• The patient has experienced an inadequate treatment response, intolerance, or contraindication to a topical steroid
• If additional quantities are being requested, then Vectical Ointment is being prescribed to treat a body surface area that requires more than 100 grams per month OR calcipotriene cream, calcipotriene topical solution, Calcitrene Topical Ointment, Enstilar Foam, Sorilux Foam, Taclonex Ointment, Taclonex Suspension, or Wynzora Cream is being prescribed to treat a body surface area that requires more than 60 units per month

Reauthorization criteria

• The requested drug is being prescribed for the treatment of psoriasis
• The patient has achieved or maintained a positive clinical response to the requested drug (e.g., clear or almost clear outcome, patient satisfaction)
• If additional quantities are being requested, then Vectical Ointment is being prescribed to treat a body surface area that requires more than 100 grams per month OR calcipotriene cream, calcipotriene topical solution, Calcitrene Topical Ointment, Enstilar Foam, Sorilux Foam, Taclonex Ointment, Taclonex Suspension, or Wynzora Cream is being prescribed to treat a body surface area that requires more than 60 units per month

Approval duration

Initial therapy 3 months; Continuation of therapy 12 months