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Otezla — Medical Mutual

Plaque Psoriasis

Initial criteria

  • Patient age ≥ 6 years; AND
  • Patient meets ONE of the following: (a) has tried at least one traditional systemic agent for psoriasis for at least 3 months, unless intolerant; OR (b) has tried ONE biologic DMARD for at least 3 months; OR (c) experienced intolerance to a trial of at least one oral therapy for plaque psoriasis; OR (d) has a contraindication to one oral agent for psoriasis as determined by the prescriber; AND
  • The medication is prescribed by or in consultation with a dermatologist

Reauthorization criteria

  • The 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