Ilumya (tildrakizumab-asmn) — Highmark
Plaque psoriasis (PsO)
Initial criteria
- Member age ≥18 years; diagnosis of moderate to severe PsO; prescribed by or in consultation with a dermatologist or rheumatologist; and one of the following: (i) therapeutic failure or intolerance to phototherapy; (ii) therapeutic failure or intolerance to at least one systemic therapy (for example, methotrexate); (iii) contraindicated to both phototherapy and systemic therapy; AND therapeutic failure or intolerance to at least two step 1 or 2a plan-preferred agents for PsO
Reauthorization criteria
- Member has demonstrated disease stability or a beneficial response to therapy