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Zoryve (roflumilast) cream 0.15% — CareFirst (Caremark)

Atopic dermatitis

Preferred products

  • topical calcineurin inhibitors
  • medium or higher potency topical corticosteroids

Initial criteria

  • The request is for Zoryve (roflumilast) CREAM 0.15%.
  • The patient is age ≥ 6 years.
  • The patient has experienced an inadequate treatment response, intolerance, OR has a contraindication to a topical calcineurin inhibitor OR a medium or higher potency topical corticosteroid.
  • If additional quantities are being requested, the drug is being prescribed to treat a body surface area that requires more than 60 grams per month.

Reauthorization criteria

  • The request is for Zoryve (roflumilast) CREAM 0.15%.
  • The patient is age ≥ 6 years.
  • The patient has achieved or maintained a positive clinical response as evidenced by improvement (e.g., improvement or resolution of erythema, edema, xerosis, erosions, excoriations, oozing, crusting, lichenification, or pruritus).
  • If additional quantities are being requested, the drug is being prescribed to treat a body surface area that requires more than 60 grams per month.