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The Policy VaultThe Policy Vault

Otezla XR — Medica

psoriatic arthritis

Initial criteria

  • Patient meets diagnostic criteria for plaque psoriasis or psoriatic arthritis per policy-specific definitions (see Recommended Authorization Criteria section).
  • Medication is not prescribed concurrently with another biologic or with a targeted synthetic oral small molecule drug used for an inflammatory condition.
  • Conventional synthetic DMARDs (e.g., methotrexate, leflunomide, hydroxychloroquine, or sulfasalazine) may be used concurrently.

Reauthorization criteria

  • Patient has demonstrated improvement or stabilization of disease compared with baseline prior to initiating Otezla/Otezla XR.
  • Examples include improvement in at least one symptom such as less joint pain, morning stiffness, or fatigue; improved function or activities of daily living; or decreased soft tissue swelling in joints or tendon sheaths.