Ilumya (tildrakizumab-asmn) — Coverage Criteria (Plaque Psoriasis)
Establishes prior authorization, coverage criteria, dosing, and conditions not recommended for Ilumya (tildrakizumab-asmn) for adults with moderate to severe plaque psoriasis under CareSource medical benefit.
No material clinical or coverage changes in this revision.
Coverage Criteria for Ilumya (tildrakizumab-asmn)
Initial Therapy — Covered when ALL of the following are met for Initial Therapy.
Covered when ALL of the following are met for Initial Therapy:
Exception: a patient who has already had a 3-month trial or intolerance to at least one biologic other than the requested drug may be exempted from the traditional systemic trial; a biosimilar of the requested biologic does not count. A patient who has already tried a biologic is not required to 'step back' to a traditional systemic agent.
Continuation Therapy (Patient Currently Receiving Ilumya) — Covered when ALL of the following are met for patients currently receiving Ilumya.
Covered when ALL of the following are met for patients currently receiving Ilumya:
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