Otezla — CareFirst (Caremark)
Behcet’s disease (oral ulcers)
Initial criteria
- Adult members
- Member has previously received a biologic indicated for treatment of Behcet’s disease OR member has had an inadequate response to at least one nonbiologic medication for Behcet’s disease (e.g., colchicine, systemic glucocorticoids, azathioprine)
- Medication not used concomitantly with any other biologic drug or targeted synthetic drug for the same indication
- Prescribed by or in consultation with a rheumatologist
Reauthorization criteria
- Adult member achieves or maintains a positive clinical response as evidenced by low disease activity or improvement in signs and symptoms of the condition
Approval duration
12 months