Hadlima — CareFirst (Caremark)

Initial criteria

• Adult members who have previously received a biologic or targeted synthetic drug (e.g., Sotyktu, Otezla) indicated for plaque psoriasis OR moderate to severe plaque psoriasis meeting any of: crucial body areas affected (e.g., hands, feet, face, neck, scalp, genitals/groin, intertriginous areas); ≥10% of BSA affected; ≥3% of BSA affected and either inadequate response or intolerance to phototherapy (e.g., UVB, PUVA) or pharmacologic treatment with methotrexate, cyclosporine, or acitretin; or clinical reason to avoid those pharmacologic treatments

Reauthorization criteria

• Adult member (including new members) using the requested medication for moderate to severe plaque psoriasis and achieves or maintains positive clinical response evidenced by low disease activity or improvement in signs and symptoms when either reduction in BSA from baseline OR improvement in signs/symptoms (e.g., itching, redness, flaking, scaling, burning, cracking, pain) is observed

Approval duration

12 months