Otezla — Medical Mutual

Initial criteria

• Patient age ≥ 18 years; AND
• Patient has oral ulcers or other mucocutaneous involvement; AND
• Patient has tried at least ONE other systemic therapy; AND
• The medication is prescribed by or in consultation with a rheumatologist or dermatologist

Reauthorization criteria

• Patient has been established on Otezla for at least 4 months; AND
• The patient has had a clinical response as determined by the prescriber

Approval duration

initial 4 months; extension 1 year