Taltz (ixekizumab) — CareFirst (Caremark)

Initial criteria

• For all indications: Member has had a documented negative tuberculosis (TB) test (TST or IGRA) within 12 months of initiating therapy, and has no active TB infection. If latent TB, treatment must be started before initiation. Member cannot use Taltz concomitantly with another biologic or targeted synthetic drug for the same indication.
• For plaque psoriasis: Member age ≥ 6 years. Authorization 12 months may be granted if member has previously received a biologic or targeted synthetic drug (e.g., Sotyktu, Otezla) indicated for moderate to severe plaque psoriasis; OR if member has moderate to severe plaque psoriasis and any of the following: crucial body areas affected (hands, feet, face, neck, scalp, genitals/groin, intertriginous areas); OR ≥10% body surface area affected; OR ≥3% BSA affected and either inadequate response or intolerance to phototherapy (UVB, PUVA) or to methotrexate, cyclosporine, or acitretin; OR clinical reason to avoid methotrexate, cyclosporine, and acitretin (see Appendix). Prescriber must be dermatologist.
• For psoriatic arthritis: Adult member. Authorization 12 months may be granted if member has previously received a biologic or targeted synthetic drug (e.g., Rinvoq, Otezla) indicated for active psoriatic arthritis; OR for active psoriatic arthritis when member has mild to moderate disease with inadequate response to methotrexate, leflunomide, or another csDMARD (e.g., sulfasalazine) administered at adequate dose/duration; OR has intolerance or contraindication to methotrexate, leflunomide, or another csDMARD; OR has enthesitis or predominantly axial disease; OR has severe disease. Prescriber must be rheumatologist or dermatologist.
• For ankylosing spondylitis (AS) or non-radiographic axial spondyloarthritis (nr-axSpA): Adult member. Authorization 12 months may be granted if member has previously received a biologic or targeted synthetic drug (e.g., Rinvoq, Xeljanz) indicated for these conditions; OR has had inadequate response to at least two NSAIDs; OR intolerance or contraindication to two or more NSAIDs. Prescriber must be rheumatologist.

Reauthorization criteria

• For plaque psoriasis: Authorization 12 months may be granted if age ≥ 6 years, already using Taltz for moderate to severe plaque psoriasis, and has positive clinical response evidenced by reduction in BSA affected or improvement in signs/symptoms (itching, redness, flaking, scaling, burning, cracking, pain).
• For psoriatic arthritis: Authorization 12 months may be granted if adult member shows positive clinical response evidenced by improvement from baseline in any of the following: number of swollen joints, number of tender joints, dactylitis, enthesitis, axial disease, skin/nail involvement, functional status, or CRP.
• For ankylosing spondylitis or nr-axSpA: Authorization 12 months may be granted if adult member shows positive clinical response evidenced by improvement from baseline in any of: functional status, total spinal pain, inflammation (morning stiffness), swollen joints, tender joints, or CRP.

Approval duration

12 months