Zoryve foam (roflumilast) — Highmark
Plaque psoriasis
Initial criteria
- age ≥ 12 years
- diagnosis of plaque psoriasis (ICD-10: L40.0)
- meets one of the following: experienced therapeutic failure, contraindication, or intolerance to one generic, formulary vitamin D analog (e.g., calcipotriene, calcitriol) OR has psoriasis on the face
Reauthorization criteria
- prescriber attests that the member has experienced positive clinical response to therapy