CurrentMass General Brigham Health PlanPolicy N/A

Sotyktu (deucravacitinib) — Prior Authorization, Quantity Limits, and Specialty Pharmacy Requirements

Prior authorization, quantity limits, and specialty pharmacy requirements for Sotyktu (deucravacitinib) for adult members with moderate to severe plaque psoriasis covered by Mass General Brigham Health Plan.

Policy Summary

PayerMass General Brigham Health Plan

PolicySotyktu (deucravacitinib) — Prior Authorization, Quantity Limits, and Specialty Pharmacy Requirements

Policy CodePolicy N/A

Change TypeCriteria and operational updates (quantity limitspecialty designationreauthorization evidence)

Effective DateSep 1, 2025

Next Review DateN/A

Key ActionSubmit prior authorization and required documentation of clinical improvement for reauthorization; ensure Sotyktu is dispensed via contracted specialty pharmacy and limited to 1 tablet per day.

SourceLink

POLICY UPDATE CHANGES

Updated Limitations section to include quantity limits and specialty designation; effective 09/01/2025.

Removed immunomodulator trial and failure requirement and updated criteria to allow bypassing conventional therapy if member has severe psoriasis that warrants a biologic DMARD as first-line therapy.

Updated reauthorization criteria to require documentation of clinical response/clinical improvement.

24 monthsapproval duration

1/dayquantity limit

>=3% BSABSA threshold

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Coverage Criteria for Sotyktu (deucravacitinib)

Initial Therapy

Authorization may be granted when ALL of the following are met:

Initial Authorization: 1) Member has a diagnosis of moderate to severe plaque psoriasis.

Initial Authorization: 2) At least 3% of body surface area (BSA) is affected OR crucial body areas (hands, feet, face, neck, scalp, genitals/groin, intertriginous areas) are affected.>= 3% BSA

Initial Authorization

ONE of: a) Failure, intolerance, or contraindication to a minimum 4‑week trial of at least one topical therapy: corticosteroids (e.g., betamethasone, clobetasol), vitamin D analogs (e.g., calcitriol, calcipotriene), tazarotene, calcineurin inhibitors (e.g., tacrolimus, pimecrolimus), anthralin, or coal tar.
Trial = minimum 4 weeks
ONE of: b) Member has severe psoriasis that warrants a biologic DMARD as first‑line therapy (biologic‑first exception).

Initial Authorization: Also allows authorization for members new to the plan within the past 90 days who are currently receiving the medication (excluding product received as samples or via manufacturer patient assistance programs).

Continuation Therapy

Requests for reauthorization will be approved when ALL of the following are met:

Reauthorization: Documentation is submitted supporting improvement in the member's condition as evidenced by low disease activity or improvement in signs and symptoms of the condition.

Approvals granted for up to 24 months; quantity limit 1 tablet per day.

This medication has been designated specialty and must be filled at a contracted specialty pharmacy. Prior authorization is required for Sotyktu; members new to the plan within the past 90 days who are currently receiving the medication may be eligible for authorization when continuity of care conditions are met. Non-specialty fill pathways are not applicable for this drug.

Use of this medication for indications other than adult moderate to severe plaque psoriasis is not covered under this policy. Requests will be denied when the required diagnosis-specific criteria are not met — for example, when documentation does not demonstrate a diagnosis of moderate to severe plaque psoriasis with either >= 3% body surface area (BSA) affected or involvement of a crucial body area (hands, feet, face, neck, scalp, genitals/groin, intertriginous areas), and when required prior therapy trials or an accepted exception rationale (such as severe disease warranting a biologic DMARD as first-line therapy) are not provided.

Key Coding & Clinical Thresholds

Body Surface Area (BSA) — clinical threshold for moderate to severe plaque psoriasis

BSA threshold>= 3% of body surface area affected

Alternative criterionInvolvement of crucial body areas (hands, feet, face, neck, scalp, genitals/groin, intertriginous areas)

ContextUsed to define moderate to severe plaque psoriasis for Sotyktu (deucravacitinib) coverage determinations

Provider Actions, Prior Authorization, and Documentation

Prior Authorization

Prior authorization required; specialty pharmacy fill mandated

Prior authorization is required for Sotyktu. The medication is designated specialty and must be filled at a contracted specialty pharmacy; non-specialty fill pathways are not applicable. Members new to the plan within the past 90 days who are currently receiving the medication may be eligible for authorization (excludes samples and manufacturer patient assistance program supplies).

Contact MassHealth UPPL for medical/specialty medications: Phone 877-519-1908, Fax 855-540-3693

Step Therapy

Prior topical therapy required or biologic-first exception allowed

Authorization requires either a minimum 4-week trial and failure, intolerance, or contraindication to at least one listed topical therapy (corticosteroids, vitamin D analogs, tazarotene, calcineurin inhibitors, anthralin, or coal tar) OR documentation that the member has severe psoriasis warranting a biologic DMARD as first-line therapy.

Topical therapy trial must be at least 4 weeks in duration.

Definitions

Moderate to severe plaque psoriasis — definition including BSA threshold and involvement of crucial body areas

DefinitionDiagnosis of moderate to severe plaque psoriasis characterized by at least 3% BSA affected or involvement of crucial body areas

Crucial body areas listedHands, feet, face, neck, scalp, genitals/groin, intertriginous areas

Prior therapy requirement (one of two paths)Either a minimum 4-week trial with failure, intolerance, or contraindication to at least one topical therapy (corticosteroids, vitamin D analogs, tazarotene, calcineurin inhibitors, anthralin, coal tar) OR severe disease warranting biologic DMARD as first-line

Background

Sotyktu (deucravacitinib) is a tyrosine kinase 2 (TYK2) inhibitor approved for the treatment of adults with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy. Coverage under this policy is aligned with disease severity — defined by involvement of >= 3% BSA or crucial body areas — and requires documentation of prior topical therapy trials (minimum 4-week trial with failure, intolerance, or contraindication) unless the member has severe disease warranting biologic therapy as first-line.

Revision History & Policy Changes

2025-09-01Operational updateLatest

Updated Limitations to include quantity limit of 1 tablet per day and designated Sotyktu as specialty requiring fill at a contracted specialty pharmacy.

2025-06-11Policy revision

Removed immunomodulator trial and failure requirement and updated Limitations section to include quantity limits (effective 09/01/2025).

2024-10-09