Spevigo (spesolimab-sbzo) subcutaneous — Highmark
generalized pustular psoriasis (GPP)
Initial criteria
- age ≥ 12 years
- member weighs ≥ 40 kg
- diagnosis of generalized pustular psoriasis (GPP) (ICD-10: L40.1)
- prescribed by or in consultation with a dermatologist
- member has experienced at least one previous GPP flare that had evidence of fresh pustulation (new or worsening pustules)
- member is not currently experiencing a GPP flare
- member requires treatment to prevent future GPP flares
Reauthorization criteria
- member has experienced positive clinical response to therapy
Approval duration
up to 12 months