Vtama (tapinarof)
Indications for Prior Authorization
Vtama (tapinarof) cream
-
For diagnosis of Plaque Psoriasis (PsO)
Indicated for the topical treatment of plaque psoriasis in adults. -
For diagnosis of Atopic Dermatitis (AD)
Indicated for the topical treatment of atopic dermatitis in adults and pediatric patients 2 years of age and older.
Criteria
Vtama
For state-mandated plans in Illinois or other states where applicable: Step therapy requirements do NOT apply. Beginning January 1, 2026, step therapy requirements or use of the authorization of alternative covered medications in a manner that effectively creates a step therapy requirement will not be imposed.
Step Therapy
Length of Approval: 12 Month(s)
For diagnosis of Plaque Psoriasis (PsO)
- Diagnosis of plaque psoriasis AND
- Trial and failure of a minimum 30-day supply (14-day supply for topical corticosteroids), contraindication, or intolerance to ONE of the following generic topical therapies [2]:
- Corticosteroids (e.g., betamethasone, clobetasol)
- Vitamin D analogs (e.g., calcitriol, calcipotriene)
- Tazarotene
- Calcineurin inhibitors (e.g., tacrolimus, pimecrolimus)
- Combination topical therapy (e.g., vitamin D analog/corticosteroid)
Vtama
For state-mandated plans in Illinois or other states where applicable: Step therapy requirements do NOT apply. Beginning January 1, 2026, step therapy requirements or use of the authorization of alternative covered medications in a manner that effectively creates a step therapy requirement will not be imposed.
Step Therapy
Length of Approval: 12 Month(s)
For diagnosis of Atopic Dermatitis (AD)
- Diagnosis of atopic dermatitis AND
- Trial and failure of a minimum 30-day supply (14-day supply for topical corticosteroids), contraindication, or intolerance to ONE of the following:
- Medium or higher potency topical corticosteroid
- Generic topical calcineurin inhibitor (e.g., tacrolimus ointment)
P & T Revisions
1970-01-01, 2025-12-18, 2025-11-21, 2025-06-04, 2025-04-30, 2025-03-05, 2025-02-09, 2024-09-08, 2024-07-03, 2023-12-01, 2023-07-06, 2022-11-03, 2022-07-13, 2022-07-14
References
- Vtama Prescribing Information. Dermavant Sciences Inc. Long Beach, CA. May 2022.
- Elmets CA, Korman NJ, Farley Prater E, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol 2021;84:432-70.
- Sidbury R, Alikhan A, Bercovitch L, et al. Guidelines of care for the management of atopic dermatitis in adults with topical therapies. J Am Acad Dermatol. 2023;89(1):e1-e20.
Revision History
- 1970-01-01: No criteria changes
- 2025-12-18: no criteria changes, added IL statute operational note
- 2025-11-21: Changed UM management from PA to ST; age criterion removed from AD criteria; reauthorization criteria removed from both indications with the ST approval duration set to 12 months
- 2025-06-04: Updated verbiage of psoriasis topical step to a minimum 30-day supply (14-day supply for topical steroids)
- 2025-04-30: Removed the prescriber requirements
- 2025-03-05: Addition of criteria for atopic dermatitis
- 2025-02-09: Addition of criteria for atopic dermatitis; added Zoryve 0.3% as an additional preferred alternative for plaque psoriasis; updated the plaque psoriasis criteria to increase from a single step to a double step
- 2024-09-08: Removed anthralin and coal tar as topical step options for PsO
- 2024-07-03: Annual review - no criteria changes; background updates
- 2023-12-01: Program update to standard reauthorization language. No changes to clinical intent.
- 2023-07-06: Annual review - no criteria changes
- 2022-11-03: Updated step to a single generic topical agent
- 2022-07-13: New program
- 2022-07-14: New program
HEALTHY LIVING