ModifiedCignaPolicy IP0671

Sotyktu Prior Authorization Policy

Defines Cigna prior authorization requirements, clinical criteria, coverage durations, and exclusions for Sotyktu for plaque psoriasis and psoriatic arthritis for affected members and prescribers.

Policy Summary

PayerCigna

PolicySotyktu Prior Authorization Policy

Policy CodePolicy IP0671

Change TypeMaterial revisions (added PsA, step-therapy exceptions, concurrent-use relocation)

Effective DateMay 1, 2026

Next Review DateN/A

Key ActionSubmit prior authorization with specialist documentation and required clinical history (age, prior therapies or contraindications, and response measures) to request coverage.

SourceLink

POLICY UPDATE CHANGES

Psoriatic Arthritis: This new condition for approval was added to the policy.

Concurrent use with other potent immunosuppressants, including methotrexate, was removed from Conditions Not Covered and relocated to apply to Plaque Psoriasis indication only.

For Plaque Psoriasis initial therapy, a 3-month trial or prior intolerance to Otezla (apremilast) was added as an exception to the requirement for a trial of one traditional systemic agent.

For Initial Therapy, the wording changed to 'according to the prescriber, the patient has a contraindication to methotrexate'.

2FDA indications covered

3 moInitial approval (Psoriasis)

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Initial approval (PsA)

1 yrRenewal duration

~30Appendix therapies

Coverage Criteria

Sotyktu (deucravacitinib) is considered not medically necessary for any indication other than plaque psoriasis or psoriatic arthritis. The policy explicitly relocates the restriction prohibiting concurrent use with certain potent immunosuppressants into the plaque psoriasis indication; separate language in the Conditions Not Covered section maintains that use outside the covered indications is not permitted. Providers should ensure requests are for one of the two FDA‑approved indications to avoid denial. (See policy revision notes regarding relocation of concurrent‑use restrictions.)

The Appendix lists multiple biologic and targeted oral agents (including Sotyktu) with mechanism and indication annotations but does not itself state additional explicit coverage exclusions for Sotyktu or other listed therapies. The appendix is provided for reference when comparing mechanisms and labeled indications and is not a standalone statement of coverage policy.

Combination therapy with Sotyktu and another biologic or a targeted synthetic oral small molecule drug for an inflammatory condition is considered not medically necessary. The policy explains that combination treatment is generally not recommended because of potentially higher adverse events and lack of controlled data demonstrating additive benefit; requests proposing concurrent use should be denied unless they meet exceptional, documented justification aligned with the policy.

This appendix portion enumerates agents (biologics, JAK/TYK2 inhibitors, and other targeted oral small molecules) and their mechanisms/indications for reference. It does not provide separate or explicit not medically necessary determinations for Sotyktu or the other listed agents; coverage determinations remain governed by the main policy criteria and Conditions Not Covered section.

Coding and Appendix Listings

Drugs listed in appendixNDC | mixed

Taltz	ixekizumab SC injection; Inhibition of IL-17A
Bimzelx	bimekizumab-bkzx SC injection; Inhibition of IL-17A/17F
Ilumya	tildrakizumab-asmn SC injection; Inhibition of IL-23
Skyrizi	risankizumab-rzaa SC injection/IV infusion; Inhibition of IL-23
Tremfya	guselkumab SC injection/IV infusion; Inhibition of IL-23
Entyvio	vedolizumab IV infusion/SC injection; Integrin receptor antagonist
Otezla	apremilast tablets; Inhibition of PDE4
Otezla XR	apremilast extended-release tablets; Inhibition of PDE4
Cibinqo	abrocitinib tablets; Inhibition of JAK pathways
Olumiant	baricitinib tablets; Inhibition of JAK pathways

1–10 of 19

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Provider Actions and Requirements

Prior Authorization

Prior Authorization Required

Prior Authorization Required. Prior authorization (PA) is required for benefit coverage of Sotyktu. All approvals are for the duration noted in the policy; when durations are expressed in months, 1 month = 30 days.

PA required for Sotyktu
Approvals issued for specified durations (1 month = 30 days)

Documentation Required

Prescriber Specialty and Documentation

Prescriber specialty and clinical documentation. Because specialized skills are required for evaluation, diagnosis, and monitoring of patients treated with Sotyktu, initial approvals require Sotyktu to be prescribed by or in consultation with a physician who specializes in the condition being treated (e.g., dermatologist for plaque psoriasis; rheumatologist or dermatologist for psoriatic arthritis). Clinical documentation should support diagnosis, prior therapy attempts or contraindications, treatment response (for continuation requests), and that Sotyktu will not be used concurrently with other potent immunosuppressants.

Background

Sotyktu (deucravacitinib) is an oral tyrosine kinase 2 (TYK2) inhibitor approved for adults with moderate to severe plaque psoriasis and for active psoriatic arthritis. The drug is listed in the appendix alongside other systemic therapies and is subject to the policy’s prior authorization and clinical criteria for initiation and continuation of therapy.

Definitions

Sotyktu — key facts

DrugDeucravacitinib tablets (Sotyktu)

MechanismTyrosine kinase 2 (TYK2) inhibitor

FDA‑approved indicationsModerate to severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy; active psoriatic arthritis in adults

Traditional systemic agent (psoriasis)

ExamplesMethotrexate, cyclosporine, acitretin, and phototherapy (PUVA)

Step requirementFor plaque psoriasis initial therapy, trial of ≥1 traditional systemic agent for ≥3 months is required unless patient is intolerant

Alternate exceptions

Policy Summary

PayerCigna

PolicySotyktu Prior Authorization Policy

Policy CodePolicy IP0671

Change TypeMaterial revisions (added PsA, step-therapy exceptions, concurrent-use relocation)

Effective DateMay 1, 2026

Next Review DateN/A

Key ActionSubmit prior authorization with specialist documentation and required clinical history (age, prior therapies or contraindications, and response measures) to request coverage.

SourceLink

On This Page

Initial prescription must be by or in consultation with a specialist (dermatologist or rheumatologist as specified)
Document prior therapies, contraindications, and treatment response when applicable
Document that Sotyktu will not be used concurrently with other potent immunosuppressants

Note

Appendix: Biologic and Targeted Oral Therapies (Informational)

Appendix reference — biologic and targeted oral therapies. The Appendix provides an informational list of biologic and targeted oral small molecule therapies (examples include IL‑17, IL‑23 inhibitors, JAK inhibitors, PDE4 inhibitor Otezla, and TYK2 inhibitor Sotyktu) and their mechanisms to aid clinical assessment and therapeutic sequencing. The Appendix is informational and does not itself create denial triggers; however, claims submitted without covered diagnosis/procedure codes or without required PA will be denied.

Appendix lists biologics (e.g., Taltz, Skyrizi, Tremfya) and targeted orals (e.g., Otezla, JAK inhibitors) and mechanisms
Appendix is informational — does not by itself specify denial criteria
Claims lacking covered diagnosis/procedure codes will be denied

A 3‑month trial or prior intolerance to at least one biologic or to apremilast (Otezla) also satisfies the step requirement; prescriber‑determined contraindication to methotrexate is an alternate pathway

Sotyktu (short identifier)

AgentSotyktu (deucravacitinib)

ClassTYK2 inhibitor

Mention in appendixListed in appendix among systemic therapies with mechanism noted as inhibition of TYK2