Otezla — Cigna

Initial criteria

• Patient age ≥ 18 years
• Patient has oral ulcers or other mucocutaneous involvement
• Patient has tried at least ONE other systemic therapy (e.g., colchicine, systemic corticosteroids, azathioprine, thalidomide, interferon alpha, or a tumor necrosis factor inhibitor such as adalimumab, etanercept, certolizumab pegol, golimumab, infliximab)
• Medication is prescribed by or in consultation with a rheumatologist or dermatologist

Reauthorization criteria

• Patient has been established on therapy for at least 4 months
• When assessed by at least one objective measure, patient experienced a beneficial clinical response from baseline (prior to initiating Otezla/Otezla XR)
• Compared with baseline, patient experienced improvement in at least one symptom (e.g., decreased pain or improved visual acuity if ophthalmic manifestations)

Approval duration

initial 4 months, reauth 1 year