Siliq — Medical Mutual

Initial criteria

• Patient is age ≥ 18 years; AND
• Patient has tried at least one traditional systemic agent for psoriasis for at least 3 months, unless intolerant (examples: methotrexate, cyclosporine, acitretin, or PUVA); OR patient has a contraindication to methotrexate; OR patient has already had a 3-month trial or intolerance to at least one biologic other than the requested drug; 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