Opzelura — Medical Mutual

Atopic Dermatitis

Initial criteria

Patient is age ≥ 12 years
Patient has mild to moderate atopic dermatitis, according to the prescriber
Patient has atopic dermatitis involvement estimated to affect ≤ 20% of the body surface area
Patient meets ONE of the following (i or ii):
i. Patient meets ALL the following criteria (a, b, and c):
a) Patient has tried at least one medium-, medium-high, high-, and/or super-high-potency prescription topical corticosteroid; AND
b) This topical corticosteroid was applied daily for at least 28 consecutive days; AND
c) Inadequate efficacy was demonstrated with this topical corticosteroid therapy, according to the prescriber; OR
ii. Patient is treating atopic dermatitis affecting one of the following areas: face, eyes/eyelids, skin folds, and/or genitalia
Patient meets ALL the following (i, ii, and iii):
i. Patient has tried at least one topical calcineurin inhibitor; AND
ii. This topical calcineurin inhibitor was applied daily for at least 28 consecutive days; AND
iii. Inadequate efficacy was demonstrated with this topical calcineurin inhibitor, according to the prescriber
The medication is prescribed by or in consultation with an allergist, immunologist, or dermatologist

Response to therapy is required for continuation of therapy unless otherwise noted

8 weeks