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Zoryve foam (roflumilast) — Highmark

Seborrheic dermatitis

Initial criteria

  • age ≥ 9 years
  • diagnosis of moderate to severe seborrheic dermatitis (ICD-10: L21)
  • meets one of the following: experienced therapeutic failure or intolerance to one generic, formulary topical corticosteroid OR has seborrheic dermatitis on the face or intertriginous areas (e.g., skin folds, genitalia)
  • if age ≥ 12 years, has experienced therapeutic failure, contraindication, or intolerance to one generic topical antifungal agent for seborrheic dermatitis (e.g., ketoconazole, ciclopirox)

Reauthorization criteria

  • prescriber attests that the member has experienced positive clinical response to therapy