Vtama (tapinarof) — CareFirst (Caremark)

Initial criteria

• The patient is age ≥ 2 years.
• The requested drug is being prescribed for the treatment of atopic dermatitis.
• The patient meets ONE of the following:
• • The requested drug will be used on sensitive skin areas (e.g. face, genitals, or skin folds) AND the patient experienced an inadequate treatment response, intolerance, or contraindication to a topical calcineurin inhibitor.
• OR
• • The patient experienced an inadequate treatment response, intolerance, or contraindication to a topical calcineurin inhibitor AND a medium or higher potency topical corticosteroid.
• If additional quantities are being requested, the requested drug is being prescribed to treat a body surface area that requires more than 60 grams per month.

Reauthorization criteria

• The patient is age ≥ 2 years.
• The patient has achieved or maintained a positive clinical response as evidenced by improvement (e.g., improvement or resolution of any of the following signs and symptoms: erythema, edema, xerosis, erosions, excoriations, oozing and crusting, lichenification, or pruritus).
• If additional quantities are being requested, the requested drug is being prescribed to treat a body surface area that requires more than 60 grams per month.

Approval duration

Initial 3 months; Reauthorization 12 months