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Cimzia — CareFirst (Caremark)

Plaque psoriasis

Initial criteria

  • Adult member
  • Previously received a biologic or targeted synthetic drug (e.g., Sotyktu, Otezla) indicated for moderate to severe plaque psoriasis OR any of the following:
  • Affected crucial body areas (hands, feet, face, neck, scalp, genitals/groin, intertriginous areas)
  • ≥10% body surface area (BSA) affected
  • ≥3% BSA affected AND (a) inadequate response or intolerance to phototherapy (UVB, PUVA) OR pharmacologic therapy with methotrexate, cyclosporine, or acitretin; OR (b) clinical reason to avoid all those pharmacologic options

Reauthorization criteria

  • Improvement in body surface area affected and/or signs and symptoms documented in chart or medical records.

Approval duration

12 months