Opzelura (ruxolitinib) — Highmark
atopic dermatitis
Preferred products
- topical tacrolimus
- topical pimecrolimus
Initial criteria
- age ≥ 12 years
- diagnosis of atopic dermatitis (ICD-10: L20.9), classified as mild to moderate
- prescriber attests that the member has body surface area (BSA) involvement up to 20% (excluding scalp)
- therapeutic failure, contraindication, or intolerance to one (1) of the following plan-preferred generic products: topical tacrolimus OR topical pimecrolimus
Reauthorization criteria
- prescriber attests that the member has experienced an improvement or response to therapy
Approval duration
initial up to 8 weeks, reauthorization up to 12 months