CurrentCignaPolicy N/A

Topical Products - Vtama and Zoryve 0.3% Cream Step Therapy Policy

Defines Cigna's step therapy requirements for coverage of Vtama (tapinarof 1% cream) and Zoryve 0.3% cream for plaque psoriasis and Vtama for atopic dermatitis; applies to health benefit plans administered by Cigna companies.

Policy Summary

PayerCigna

PolicyTopical Products - Vtama and Zoryve 0.3% Cream Step Therapy Policy

Policy CodePolicy N/A

Change TypeCriteria additions and age expansion

Effective DateN/A

Next Review DateOct 16, 2024

Key ActionObtain prior authorization and document prior Step 1 therapy, patient age, diagnosis, and affected body area when requesting Vtama or Zoryve 0.3% cream.

SourceLink

POLICY UPDATE CHANGES

Vtama: Added option of approval for Vtama in a patient with atopic dermatitis.

Vtama: Added approval option for atopic dermatitis affecting face, eyes/eyelids, axilla, or genitalia.

Zoryve age criterion expanded from >12 years to ≥6 years.

2Step 2 products covered (Vtama, Zoryve 0.3% cream)

3Step 1 categories required before Step 2

≥6Min age for Zoryve

>2Min age for Vtama (AD)

1 yrApproval duration (authorizations)

Coverage Criteria

Any use of Vtama (tapinarof 1% cream) or Zoryve 0.3% cream that does not meet the step therapy criteria outlined in this policy is considered not medically necessary.

Requests for these Step 2 products that lack the required prior Step 1 trials or applicable exception criteria are considered not medically necessary. Specifically, approvals require meeting the step therapy pathways described for Vtama (Section 1) or Zoryve 0.3% cream (Section 2); missing the required Step 1a/1b or Step 1c trials (or the documented exception such as age or affected-area criteria) does not meet medical necessity and may be denied.

Coding & Age Limits

Product names referencedNDC | mixed

Vtama	tapinarof 1% cream (Dermavant) — product name referenced
Zoryve 0.3% cream	roflumilast 0.3% cream (Arcutis Biotherapeutics) — product name referenced

inv-06: Minimum age for Zoryve 0.3% cream

Minimum agePatient must be ≥ 6 years of age for Zoryve 0.3% cream

Indication context

Policy Summary

PayerCigna

PolicyTopical Products - Vtama and Zoryve 0.3% Cream Step Therapy Policy

Policy CodePolicy N/A

Change TypeCriteria additions and age expansion

Effective DateN/A

Next Review DateOct 16, 2024

Key ActionObtain prior authorization and document prior Step 1 therapy, patient age, diagnosis, and affected body area when requesting Vtama or Zoryve 0.3% cream.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Provider Actions & Documentation Requirements

Prior Authorization

Prior Authorization Required

Prior authorization is required for Vtama and Zoryve 0.3% cream. Approvals are provided for 1 year when the step therapy criteria are met.

Affected products: Vtama; Zoryve 0.3% cream
Approval duration: 1 year

Step Therapy

Step Therapy Trial Requirements

Requests for Vtama or Zoryve 0.3% cream must document prior use of the required Step 1 products. The policy requires a trial of either (a) one Step 1a topical corticosteroid AND one Step 1b vitamin D analog, or (b) one Step 1c combination product where applicable per the clinical criteria.

Document dates and durations of trials of Step 1 products
If using the Step 1a + Step 1b pathway, both must have been tried prior to Step 2 unless an exception in the clinical criteria applies
Alternative pathway: a trial of one Step 1c product satisfies the requirement

Documentation Required

Documentation Required with Request

Providers must include documentation with the prior authorization request showing prior use of required Step 1 products, patient age, diagnosis (e.g., plaque psoriasis or atopic dermatitis), affected body area(s) when relevant, and any clinical rationale for bypassing a Step 1 trial (if applicable).

Specify which Step 1 product(s) were used (Step 1a, 1b, or 1c), dates of use, and outcome (ineffective, not tolerated, contraindicated)
For pediatric requests, include patient age to confirm age-based eligibility (Vtama: ≥18 or >2 for atopic dermatitis criteria; Zoryve: ≥6)
Indicate affected areas (face, eyes/eyelids, skin folds, genitalia, axilla) when relevant to criteria

Denial Risk

Noncompliant Requests May Be Denied

Requests that do not meet the step therapy criteria (including absence of documented trials of required Step 1 products or missing required clinical information) may be considered not medically necessary and can be denied.

Ensure prior use of required Step 1 products is documented to avoid denial
Incomplete documentation of age, diagnosis, or prior therapy increases risk of denial

Definitions

inv-13: Vtama (tapinarof 1% cream) indications — plaque psoriasis in adults and atopic dermatitis in patients >2 years

Indications (plaque psoriasis)Vtama (tapinarof 1% cream) is indicated for the topical treatment of plaque psoriasis in adults (≥ 18 years)

Indications (atopic dermatitis)Vtama is indicated for the topical treatment of atopic dermatitis in patients > 2 years of age

Approval criteria notePolicy approves Vtama when patient meets either adult plaque psoriasis pathway (age ≥18 plus step-therapy or area exceptions) OR atopic dermatitis pathway (>2 years with required prior corticosteroid or affected-area exception)

inv-14: Zoryve 0.3% cream (roflumilast) indication — plaque psoriasis in patients ≥6 years

IndicationZoryve 0.3% cream (roflumilast) is indicated for the topical treatment of plaque psoriasis

Minimum age for indicationIndicated for patients ≥ 6 years of age

Approval criteria notePolicy requires patient ≥ 6 years and additional step-therapy or affected-area conditions for approval

Background

Vtama (tapinarof 1% cream) and Zoryve 0.3% cream (roflumilast) are newer topical, non-systemic therapies for plaque psoriasis with specific labeled age indications and roles in therapy. Vtama is indicated for plaque psoriasis in adults and also for atopic dermatitis in patients >2 years of age; the policy provides approval pathways for adults with plaque psoriasis and for patients >2 years when used for atopic dermatitis. Zoryve 0.3% cream is indicated for plaque psoriasis in patients ≥6 years of age and the policy requires patients to meet age and step therapy requirements before approval. Standard initial topical treatments for plaque psoriasis include topical corticosteroids and vitamin D analogs; this step therapy program encourages use of those Step 1 options before coverage of these Step 2 agents unless an exception applies.

OpenPayer