Tremfya (guselkumab) — CareFirst (Caremark)

moderate to severe plaque psoriasis (PsO)

Initial criteria

Member age ≥ 18 years
Medication prescribed by or in consultation with a dermatologist
Member has had a documented negative tuberculosis (TB) test (TST or IGRA) within 12 months prior to initiating therapy; if positive, further testing confirms no active disease and latent TB is treated before starting Tremfya
Member will not use Tremfya concomitantly with any other biologic drug or targeted synthetic drug for the same indication
Member has previously received a biologic or targeted synthetic drug (e.g., Sotyktu, Otezla) indicated for moderate to severe plaque psoriasis OR any of the following:
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% BSA is affected AND either:
Inadequate response or intolerance to phototherapy (e.g., UVB, PUVA) or pharmacologic treatment with methotrexate, cyclosporine, or acitretin
Clinical reason to avoid pharmacologic treatment with methotrexate, cyclosporine, and acitretin (e.g., liver disease, pregnancy, drug interaction, risk of toxicity)

Authorization of 12 months may be granted for members using Tremfya for moderate to severe plaque psoriasis who achieve or maintain a positive clinical response as evidenced by:
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)

12 months