Hyrimoz — CareFirst (Caremark)

Initial criteria

• Member is an adult (age ≥ 18 years)
• Member has previously received a biologic or targeted synthetic drug (e.g., Sotyktu, Otezla) indicated for psoriasis OR has moderate to severe plaque psoriasis involving crucial body areas (e.g., hands, feet, face, neck, scalp, genitals/groin, intertriginous areas) OR at least 10% body surface area (BSA) affected OR at least 3% BSA affected with inadequate response or intolerance to phototherapy (e.g., UVB, PUVA) or pharmacologic treatment with methotrexate, cyclosporine, or acitretin OR clinical reason to avoid these drugs

Reauthorization criteria

• Member is an adult with moderate to severe plaque psoriasis and has a positive clinical response with reduction in BSA affected from baseline OR improvement in signs and symptoms (e.g., itching, redness, flaking, scaling, burning, cracking, pain)

Approval duration

12 months