Cosentyx (secukinumab) — CareFirst (Caremark)

moderate to severe plaque psoriasis (PsO)

Initial criteria

Member age ≥ 6 years
Authorization may be granted if member has previously received a biologic or targeted synthetic drug (e.g., Sotyktu, Otezla) indicated for moderate to severe plaque psoriasis
OR member meets one of the following:
Crucial body areas (e.g., hands, feet, face, neck, scalp, genitals/groin, intertriginous areas) are affected
At least 10% of body surface area (BSA) is affected
At least 3% BSA affected AND member has one of: inadequate response or intolerance to phototherapy (UVB, PUVA) or methotrexate, cyclosporine, or acitretin; OR clinical reason to avoid methotrexate, cyclosporine, and acitretin
Negative tuberculosis (TB) test within 12 months of initiating therapy
Requested medication not used concomitantly with other biologic or targeted synthetic drug for same indication

Member age ≥ 6 years
Member achieves or maintains positive clinical response evidenced by low disease activity or improvement in signs and symptoms when one of the following is met: reduction in BSA affected from baseline OR improvement in signs/symptoms (itching, redness, flaking, scaling, burning, cracking, pain)
Member continues to meet TB and concomitant therapy requirements

12 months