VTAMA (tapinarof cream)

VTAMA (tapinarof cream)

Self-Administration – topical

Diagnosis considered for coverage:

• Indicated for the topical treatment of plaque psoriasis in adults. 

Prior Authorization Criteria:

For diagnosis of plaque psoriasis:

• Dose does not exceed applying once daily to affected areas, AND
• Patient is 18 years or older, AND
• Diagnosis of plaque psoriasis (supported by chart note documentation), AND
• Prescribed by or in consultation with a dermatologist, AND
• One of the following (A or B):
  • A. Minimum duration of a 4-week trial and failure, contraindication, or intolerance to TWO of the following topical therapies:
    • Corticosteroids (i.e., betamethasone, clobetasol) 
    • Vitamin D analogs (i.e.., calcitriol, calcipotriene) 
    • Tazarotene 
    • Calcineurin inhibitors (i.e.., tacrolimus, pimecrolimus) 
    • Anthralin 
    • Coal tar, OR
  • B. Minimum duration of a 4-week trial and failure, contraindication, or intolerance to ONE of the following topical combination therapies:
    • Vitamin D analog/corticosteroid (i.e., Enstilar, Taclonex, Wynzora) 
    • Duobrii (halobetasol/tazarotene) 
       

Reauthorization Criteria:

For diagnosis of plaque psoriasis:

• Documentation of positive clinical response to therapy evidenced by ONE of the following:
  • Reduction in the body surface area (BSA) involvement from baseline
  • Improvement in symptoms (i.e., pruritus, inflammation) from baseline

Coverage Duration: 

• Initial: 6 months

• Reauthorization: 1 year

Authorization is not covered for the following:

The use of this drug for indications not listed in this policy does not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics (P&T) Committee.

Additional Information: 

•    Vtama is not for intravaginal, oral, or ophthalmic use. 

Policy Updates:

• 11/15/2022 – New policy approved by P&T.

References:

1.    Accessdata.fda.gov. 2022. [online] Available at: <https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/215272s000lbl.pdf> [Accessed 26 August 2022].
2.    Vtama Prescribing Information. Dermavant Sciences Inc. Long Beach, CA. May 2022. 
3.    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.