Siliq — Medica
plaque psoriasis
Preferred products
- Enbrel
- adalimumab-adbm
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
- Otezla
- Skyrizi subcutaneous (pen or syringe)
- Sotyktu
- Imuldosa subcutaneous
- Selarsdi subcutaneous
- ustekinumab-ttwe subcutaneous
- Yesintek subcutaneous
- Taltz
- Tremfya subcutaneous
Initial criteria
- Patient meets the standard Inflammatory Conditions – Siliq Prior Authorization Policy criteria for plaque psoriasis
- Patient has tried TWO of Enbrel, an adalimumab product, Otezla, Skyrizi subcutaneous, Sotyktu, an ustekinumab subcutaneous product, Taltz, and Tremfya subcutaneous [documentation required]
Reauthorization criteria
- Patient meets the standard Inflammatory Conditions – Siliq Prior Authorization Policy criteria for plaque psoriasis
- Patient meets ONE of the following:
- a) Tried TWO of Enbrel, an adalimumab product, Otezla, Skyrizi subcutaneous, Sotyktu, an ustekinumab subcutaneous product, Taltz, and Tremfya subcutaneous [documentation required]
- b) Established on Siliq ≥ 90 days with paid claims verification or prescriber attestation if claims history unavailable
Approval duration
initial 3 months; reauthorization 1 year