Taltz (ixekizumab) — United Healthcare

Plaque Psoriasis

Preferred products

Diagnosis of chronic moderate to severe plaque psoriasis
EITHER (for adults ≥18 years):
- ≥3% body surface area involvement, palmoplantar, facial, genital involvement, or severe scalp psoriasis
- AND history of failure to one topical therapy unless contraindicated or adverse effects (document drug, date, duration): corticosteroids, vitamin D analogs, tazarotene, calcineurin inhibitors, anthralin, or coal tar
- AND history of failure to a 3 month trial of methotrexate at maximally indicated dose unless contraindicated or adverse effects (document date and duration)
- OR previously treated with a targeted immunomodulator FDA-approved for plaque psoriasis (document drug/date/duration; e.g., Cimzia, adalimumab, Otezla, Skyrizi, ustekinumab, Tremfya, Enbrel)
- AND history of failure, contraindication, or intolerance to three preferred products: one of the preferred adalimumab products, Cimzia, Cosentyx, Enbrel, Skyrizi, Sotyktu, one of the preferred ustekinumab products, Tremfya
OR (for patients <18 years):
- Diagnosis of chronic moderate to severe plaque psoriasis
- AND history of failure, contraindication, or intolerance to Cosentyx, Enbrel, or one of the preferred ustekinumab products
Patient is not receiving Taltz in combination with another targeted immunomodulator [e.g., Enbrel, Cimzia, Simponi, Orencia, adalimumab, ustekinumab, Skyrizi, Tremfya, Cosentyx, Siliq, Ilumya, Xeljanz, Olumiant, Rinvoq, Sotyktu, Otezla]
Prescribed by or in consultation with a dermatologist

12 months