Zoryve 0.3% cream — Medical Mutual

Preferred products

• Topical Corticosteroids Groups 1-4
• calcipotriene (cream, foam, ointment, solution) (Dovonex, generic, Sorilux)
• calcitriol ointment (Vectical, generic)
• calcipotriene + betamethasone dipropionate (Taclonex generic, Enstilar, Wynzora)
• pimecrolimus cream (Elidel, generic)
• tacrolimus ointment (Protopic, generic)

Initial criteria

• Prescribed by or in consultation with a physician who specializes in the condition being treated
• Patient is ≥ 6 years of age
• Patient has tried one Step 1a Product AND one Step 1b product OR Patient has tried one Step 1c Product OR Patient is treating plaque psoriasis affecting face, eyes/eyelids, skin folds, and/or genitalia AND has tried one Step 1b product

Reauthorization criteria

• Response to therapy is required for continuation of therapy

Approval duration

2 years