Sotyktu (deucravacitinib) — CareFirst (Caremark)

Initial criteria

• Medication must be prescribed by or in consultation with a dermatologist
• Member is age ≥ 18 years
• Authorization of 12 months may be granted for adult members who have previously received a biologic or targeted synthetic drug (e.g., Otezla) indicated for treatment of moderate to severe plaque psoriasis
• OR authorization of 12 months may be granted for adult members for treatment of moderate to severe plaque psoriasis when any of the following are met:
• • Crucial body areas (e.g., hands, feet, face, neck, scalp, genitals/groin, intertriginous areas) are affected
• • At least 10% of body surface area (BSA) is affected
• • At least 3% of body surface area (BSA) is affected AND member has had an inadequate response or intolerance to either phototherapy (e.g., UVB, PUVA) or pharmacologic treatment with methotrexate, cyclosporine, or acitretin OR member has a clinical reason to avoid methotrexate, cyclosporine, and acitretin (e.g., liver disease, drug interaction, pregnancy, breastfeeding, comorbidity, hypersensitivity, or history of intolerance)
• Member has a documented negative tuberculosis (TB) test (TST or IGRA) within 12 months of initiating therapy if naïve to biologic or targeted synthetic drugs associated with increased risk of TB
• If TB screening is positive, further testing must confirm no active disease before use; if latent TB is present, treatment must be initiated before therapy
• Medication cannot be used concomitantly with any other biologic drug or targeted synthetic drug

Reauthorization criteria

• Authorization of 12 months may be granted if member is continuing therapy and has achieved or maintained a positive clinical response as evidenced by either:
• • Reduction in body surface area (BSA) affected from baseline OR
• • Improvement in signs and symptoms from baseline (e.g., itching, redness, flaking, scaling, burning, cracking, pain)

Approval duration

12 months