Otezla — CareFirst (Caremark)

Initial criteria

• Member age ≥ 6 years
• Member has previously received a biologic or targeted synthetic drug (e.g., Rinvoq, Xeljanz) indicated for active psoriatic arthritis OR any of the following:
• Member has had an inadequate response to methotrexate, leflunomide, or another conventional synthetic drug (e.g., sulfasalazine) administered at an adequate dose and duration
• Member has an intolerance or contraindication to methotrexate, leflunomide, or another conventional synthetic drug (e.g., sulfasalazine)
• Member has enthesitis
• 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 or dermatologist

Reauthorization criteria

• Member age ≥ 6 years
• Member achieves or maintains a positive clinical response as evidenced by improvement from baseline in any of the following: number of swollen joints, number of tender joints, dactylitis, enthesitis, axial disease, skin and/or nail involvement, functional status, or C-reactive protein (CRP)

Approval duration

12 months