Ilumya (tildrakizumab-asmn) — Medical Mutual

Initial criteria

• Patient is age ≥ 18 years; AND
• Patient meets ONE of the following (a or b): a) Patient has tried at least one traditional systemic agent for psoriasis for at least 3 months, unless intolerant; OR b) Patient has a contraindication to methotrexate, as determined by the prescriber; AND
• Medication is prescribed by or in consultation with a dermatologist

Reauthorization criteria

• Patient has been established on therapy for at least 90 days; AND
• Patient experienced a beneficial clinical response, defined as improvement from baseline in at least one of the following: estimated body surface area, erythema, induration/thickness, and/or scale of areas affected by psoriasis; AND
• Compared with baseline, patient experienced an improvement in at least one symptom, such as decreased pain, itching, and/or burning

Approval duration

initial: 3 months; reauth: 1 year