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Zoryve (roflumilast) foam — CareFirst (Caremark)

Plaque psoriasis

Preferred products

  • topical steroids

Initial criteria

  • The request is for Zoryve (roflumilast) FOAM.
  • The patient is age ≥ 12 years.
  • The requested drug will be used on the scalp or body.
  • The patient meets ONE of the following: experienced an inadequate treatment response, intolerance, OR has a contraindication to a topical steroid; OR the drug will be used on sensitive skin areas (e.g., face, genitals, skin folds).
  • 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) FOAM.
  • The patient is age ≥ 12 years.
  • The patient has achieved or maintained a positive clinical response to therapy (e.g., clear or almost clear outcome, patient satisfaction).
  • 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.