Otezla — Cigna

Initial criteria

• Patient age ≥ 6 years
• If Otezla is being requested, patient weight ≥ 20 kg OR if Otezla XR is being requested, patient weight ≥ 50 kg
• Medication is prescribed by or in consultation with a rheumatologist or dermatologist

Reauthorization criteria

• Patient has been established on the requested drug for at least 6 months
• Patient experienced a beneficial clinical response from baseline when assessed by at least one objective measure OR patient experienced improvement in at least one symptom such as less joint pain, morning stiffness, or fatigue; improved function or activities of daily living; decreased soft tissue swelling in joints or tendon sheaths

Approval duration

1 year