apremilast (Otezla®)

SELF ADMINISTRATION - ORAL

Indications for Prior Authorization:

  • Psoriatic Arthritis
  • Plaque Psoriasis

Otezla is a preferred agent for the treatment of the following indication(s) when all criteria below are met for specific indication(s):

  • Plaque Psoriasis

Patients must meet the following criteria for the following indications (as confirmed by medical records documentation):

Psoriatic Arthritis

  • Diagnosis of active psoriatic arthritis AND
  • Failure of or clinically significant adverse effects to methotrexate, AND
  • The patient has tried and failed at least one preferred agent (Humira, Enbrel, Stelara, Cosentyx, Xeljanz/XR)

Plaque Psoriasis

  • Diagnosis of moderate to severe plaque psoriasis confirmed by a dermatologist or rheumatologist ; affects 10% or more of the body; psoriasis involves hands, feet, head, and neck or genitalia AND
  • Prescribed by a Dermatologist or Rheumatologist AND
  • Failure or clinically significant adverse effects to methotrexate either alone or in combination OR
  • If methotrexate is contraindicated, failure or clinically significant adverse effects to PUVA, UVB, cyclosporin, or acitretin

The Following Conditions Do Not Meet the Criteria for Use as Established by the WHA P & T Committee:

  • All non-FDA approved uses not listed in the approved indications

Dosing:

  • Titrate to recommended dose of 30 mg PO BID according to the following schedule:
  • Day 1:  10 mg PO AM
  • Day 2:  10mg PO AM and PM
  • Day 3:  10mg PO AM and 20 mg PO PM
  • Day 4:  20mg PO AM and PM
  • Day 5:  20mg PO AM and 30 mg PO PM
  • Day 6 and thereafter:  30 mg PO BID

Approval:

  • Initial approval 4 months to assess patient's response
  • Renewal for one year if patient has clinical response

Last review date: April 30, 2019