Vtama (tapnarof 1% cream) — Medical Mutual
atopic dermatitis
Preferred products
- Topical corticosteroids (medium-, medium-high, high-, super-high potency: betamethasone dipropionate augmented, clobetasol propionate, diflorasone diacetate, fluocinonide, flurandrenolide, halobetasol propionate, amcinonide, desoximetasone, halcinonide, mometasone furoate, triamcinolone acetonide, betamethasone valerate, fluocinonide-E, fluticasone propionate, hydrocortisone valerate, prednicarbate)
- Topical vitamin D analogs: calcipotriene (cream, foam, ointment, solution), calcitriol ointment, Sorilux
- Combination products: calcipotriene + betamethasone dipropionate (Taclonex ointment, suspension; Enstilar; Wynzora)
- Topical calcineurin inhibitors: pimecrolimus 1% cream (Elidel), tacrolimus 0.03% and 0.1% ointment (Protopic)
Initial criteria
- Prescribed by or in consultation with a physician who specializes in the condition
- Vtama: Patient age ≥ 18 years AND has tried one Step 1a Product and one Step 1b Product OR has tried one Step 1c Product OR has plaque psoriasis affecting face, eyes/eyelids, skin folds, and/or genitalia AND has tried one Step 1b Product
- Vtama: Patient age > 2 years AND diagnosis of atopic dermatitis AND has tried one Step 1a Product and one Step 1d Product OR has atopic dermatitis affecting face, eyes/eyelids, axilla, or genitalia AND has tried one Step 1d Product
- Zorvye 0.3% cream: Patient age ≥ 6 years AND has tried one Step 1a Product and one Step 1b Product OR has tried one Step 1c Product OR has plaque psoriasis affecting face, eyes/eyelids, skin folds, and/or genitalia AND has tried one Step 1b Product
- Zorvye 0.15% cream: Patient age ≥ 6 years AND diagnosis of atopic dermatitis AND has tried one Step 1a Product and one Step 1d Product OR has atopic dermatitis affecting face, eyes/eyelids, axilla, or genitalia AND has tried one Step 1d Product
Reauthorization criteria
- Response to therapy is required for continuation of therapy
Approval duration
2 years