Opzelura (ruxolitinib 1.5% cream) — Cigna

Nonsegmental vitiligo

Initial criteria

Patient age ≥ 12 years; AND
Patient has nonsegmental vitiligo; AND
Patient has vitiligo involvement estimated to affect ≤ 10% of the body surface area; AND
Patient meets ONE of the following (i or ii):
i. Patient meets ALL of the following (a, b, and c):
a) Patient has tried at least one high- and/or super-high-potency prescription topical corticosteroid; AND
Note: Concomitant use of a topical corticosteroid with a topical calcineurin inhibitor would meet the requirement.
b) The duration of this topical corticosteroid therapy was at least 12 weeks (intermittent or continuous); AND
c) According to the prescriber, inadequate efficacy was demonstrated with this topical corticosteroid therapy; OR
ii. Patient meets ALL of the following (a, b, and c):
a) Patient has tried at least one topical calcineurin inhibitor; AND

6 months