Calcitrene — 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 ONE of the following is met:
• - Vectical Ointment is being prescribed to treat a body surface area that requires more than 100 grams per month.
• - 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, etc.).
• If additional quantities are being requested, then ONE of the following is met:
• - Vectical Ointment is being prescribed to treat a body surface area that requires more than 100 grams per month.
• - 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: 3 months; Continuation: 12 months