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Zoryve (roflumilast) foam — CareFirst (Caremark)

Seborrheic dermatitis

Preferred products

  • topical ketoconazole products
  • topical ciclopirox products

Initial criteria

  • The request is for Zoryve (roflumilast) FOAM.
  • The patient is age ≥ 9 years.
  • The patient meets ONE of the following: patient is < 16 years of age; OR patient has experienced an inadequate treatment response, intolerance, OR has a contraindication to a topical ketoconazole (2% shampoo, 2% cream, 2% foam) OR a topical ciclopirox (0.77% gel, 1% shampoo) product.
  • 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 ≥ 9 years.
  • The patient has achieved or maintained a positive clinical response to therapy (e.g., clear or almost clear outcome, improvement from baseline).
  • 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.