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Vectical (calcitriol) Ointment — CareFirst (Caremark)

psoriasis

Preferred products

  • topical steroid

Initial criteria

  • Authorization may be granted when the requested drug is being prescribed for the treatment of psoriasis when ALL of the following criteria are met:
  • The patient has experienced an inadequate treatment response, intolerance, or contraindication to a topical steroid.
  • The patient meets ONE of the following:
  • If additional quantities are being requested, then Vectical Ointment is being prescribed to treat a body surface area that requires more than 100 grams per month.
  • If additional quantities are being requested, then calcipotriene cream, calcipotriene topical solution, Calcitrene Topical Ointment, Enstilar Foam, Sorilux Foam, Taclonex Ointment, Taclonex Suspension, or Wynzora Cream is being prescribed to treat a body surface area that requires more than 60 units per month.

Reauthorization criteria

  • Authorization may be granted when the requested drug is being prescribed for the treatment of psoriasis when ALL of the following criteria are met:
  • The patient has achieved or maintained a positive clinical response to the requested drug (e.g., clear, or almost clear outcome, patient satisfaction, etc.).
  • The patient meets ONE of the following:
  • If additional quantities are being requested, then Vectical Ointment is being prescribed to treat a body surface area that requires more than 100 grams per month.
  • If additional quantities are being requested, then calcipotriene cream, calcipotriene topical solution, Calcitrene Topical Ointment, Enstilar Foam, Sorilux Foam, Taclonex Ointment, Taclonex Suspension, or Wynzora Cream is being prescribed to treat a body surface area that requires more than 60 units per month.

Approval duration

Initial therapy: 3 months; Continuation of therapy: 12 months