Vectical Ointment — CareFirst (Caremark)

Preferred products

• topical steroid

Initial criteria

• The patient has experienced an inadequate treatment response, intolerance, or contraindication to a topical steroid.
• 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 OR 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

• The patient has achieved or maintained a positive clinical response to the requested drug (e.g., clear, or almost clear outcome, patient satisfaction, etc.).
• 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 OR 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