Tazorac — CareFirst (Caremark)

Initial criteria

• The requested drug is being prescribed for the treatment of plaque psoriasis AND ALL of the following criteria are met:
• • The plaque psoriasis affects ≤ 20% of the patient’s body surface area (BSA).
• • The patient meets ONE of the following:
• – The patient has experienced an inadequate treatment response to at least ONE topical corticosteroid.
• – The patient has experienced an intolerance to at least ONE topical corticosteroid.
• – The patient has a contraindication that would prohibit a trial of ALL topical corticosteroids.

Reauthorization criteria

• The requested drug is being prescribed for the treatment of plaque psoriasis AND ALL of the following criteria are met:
• • The plaque psoriasis affects ≤ 20% of the patient’s body surface area (BSA).
• • The patient has achieved or maintained a positive clinical response as evidenced by improvement (e.g., clear or almost clear outcome, patient satisfaction, etc.).

Approval duration

Initial: 3 months; Continuation: 36 months