Tremfya — Medical Mutual

Initial criteria

• Patient age ≥ 18 years AND
• Patient meets ONE: tried ≥1 traditional systemic agent for psoriasis for ≥3 months unless intolerant; OR 3-month trial or intolerance to ≥1 biologic; OR contraindication to methotrexate
• Tremfya prescribed by or in consultation with a dermatologist
• Site of care medical necessity is met

Reauthorization criteria

• Patient has been established on Tremfya ≥ 3 months AND
• Patient experienced a beneficial clinical response defined as improvement from baseline in at least one of body surface area, erythema, induration/thickness, or scale of psoriasis AND
• Improved at least one symptom (e.g., decreased pain, itching, burning)
• Site of care medical necessity is met

Approval duration

initial 3 months; reauth 1 year