Hyrimoz — CareFirst (Caremark)

Initial criteria

• Member age ≥ 12 years
• Member has previously received a biologic indicated for hidradenitis suppurativa OR has had an inadequate response to an oral antibiotic used for hidradenitis suppurativa for at least 90 days (e.g., clindamycin, metronidazole, moxifloxacin, rifampin, tetracyclines) OR intolerance or contraindication to these oral antibiotics

Reauthorization criteria

• Member age ≥ 12 years with moderate to severe hidradenitis suppurativa and has a positive clinical response with low disease activity or improvement in signs and symptoms as shown by reduction in abscess and inflammatory nodule count from baseline or reduced formation of new sinus tracts and scarring

Approval duration

12 months