Opzelura (ruxolitinib cream) — CareFirst (Caremark)

Initial criteria

• Drug is prescribed for topical short-term and non-continuous chronic treatment of mild to moderate atopic dermatitis in a non-immunocompromised patient
• Drug is NOT prescribed in combination with therapeutic biologics, other janus kinase (JAK) inhibitors, or potent immunosuppressants such as azathioprine or cyclosporine
• Patient age ≥ 12 years
• Patient’s disease is NOT adequately controlled with other topical prescription therapies (e.g., medium or higher potency topical corticosteroid, topical calcineurin inhibitor) OR other topical prescription therapies are NOT advisable (e.g., medium or higher potency topical corticosteroid, topical calcineurin inhibitor)
• Drug will NOT be applied to affected areas > 20% body surface area (BSA)
• If additional quantities are requested, drug is prescribed to treat a body surface area that requires more than 60 grams per 28 days

Reauthorization criteria

• Drug is prescribed for topical short-term and non-continuous chronic treatment of mild to moderate atopic dermatitis in a non-immunocompromised patient
• Drug is NOT prescribed in combination with therapeutic biologics, other janus kinase (JAK) inhibitors, or potent immunosuppressants such as azathioprine or cyclosporine
• Patient age ≥ 12 years
• Patient has achieved or maintained a positive clinical response as evidenced by improvement (e.g., improvement in or resolution of erythema, edema, xerosis, erosions, excoriations, oozing and crusting, lichenification, or pruritus)
• Drug will NOT be applied to affected areas > 20% BSA
• If additional quantities are requested, drug is prescribed to treat a body surface area that requires more than 60 grams per 28 days

Approval duration

Initial: 3 months; Reauthorization: 12 months