Vtama (tapinarof) — CareFirst (Caremark)

Initial criteria

• The requested drug is being prescribed for the treatment of plaque psoriasis.
• The patient meets ONE of the following:
• • The patient has experienced an inadequate treatment response, intolerance, or contraindication to a topical steroid.
• OR
• • The requested drug will be used on sensitive skin areas (e.g., face, genitals, or skin folds).
• 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 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, the requested drug is being prescribed to treat a body surface area that requires more than 60 grams per month.

Approval duration

Initial 4 months; Reauthorization 12 months