Filsuvez (birch triterpenes topical gel) — Medica

Initial criteria

• Patient is ≥ 6 months of age
• Patient has at least one clinical feature of dystrophic epidermolysis bullosa [documentation required] (e.g., blistering, wounds, scarring)
• Patient has one or more open wound(s) that will be treated (i.e., target wound[s])
• According to the prescriber, target wound(s) meet ALL of the following: target wound(s) is clean in appearance and not infected; target wound(s) is 10 cm² to 50 cm²; target wound(s) is ≥ 21 days and < 9 months old; squamous cell and/or basal cell carcinoma has been ruled out for the target wound(s)
• Medication is prescribed by or in consultation with a dermatologist or wound care specialist

Reauthorization criteria

• According to the prescriber, the target wound(s) remains open
• According to the prescriber, the target wound(s) has decreased in size from baseline
• Medication is prescribed by or in consultation with a dermatologist or wound care specialist

Approval duration

3 months