Ixekizumab (Taltz)

OFFICE / HOME HEALTH/ SELF ADMINISTRATION

Indications for Prior Authorization:
  • Treatment of adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy
  • Active Psoriatic Arthritis
Patients must meet the following criteria for the indications above:

Moderate to Severe Plaque Psoriasis:

  • Diagnosis of chronic moderate-to-severe plaque psoriasis confirmed by a dermatologist or rheumatologist (psoriasis affects 10% or more of the body; psoriasis involves hands, feet, head, and neck or genitalia), AND
  • Prescribed by dermatologist or rheumatologist, AND
  • Patient has tried and failed topical therapy (e.g., Dovonox, Tazorac, other topical steroids), AND
  • Documented failure or clinically significant adverse effects to one of the following therapies alone or in combination, unless contraindicated: methotrexate (doses up to 15-20 mg per week) or (if methotrexate is contraindicated) cyclosporine, aceitretin, or a trial with PUVA or UVB, AND
  • Documented failure or clinically significant adverse effects to at least three of the following: Humira, Otezla, Stelara, Cosentyx or Tremfya

Psoriatic Arthritis:

  • Diagnosis of active psoriatic arthritis made at baseline prior to initiation of DMARD therapy confirmed by rheumatologist or dermatologist
    • Need copy of ESR or CRP labs
    • Number of swollen joints
    • Number of painful/tender joings
    • Duration of morning stiffness, AND
  • Patient has failed to respond, or had clinically significant adverse effects to methotrexate unless contraindicated, AND
  • Inadequate response, intolerance, or contraindication to two of the following: Humira, Enbrel, Stelara, Cosentyx, or Xeljanz/XR
Dosing:
  • Plaque Psoriasis: 160 mg (two 80 mg injections) at week 0, followed by 80 mg at weeks 2, 4, 6, 8, 10 and 12, then 80 mg every 4 weeks
  • Psoriatic Arthritis: 160 mg (two 80 mg injections) at week 0, followed by 80 mg every 4 weeks
Approval:
  • One year to assess patient's response
Risk of Tuberculosis:

Patients should be evaluated for latent tuberculosis infection with a TB skin test.  Treatment of latent tuberculosis infection should be initiated prior to therapy with Taltz

Last review date: April 30, 2019