CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Taltz (ixekizumab) — Coverage Criteria

Defines prior authorization, documentation, and continuation criteria for Taltz (ixekizumab) for Plaque Psoriasis (≥6 years), Psoriatic Arthritis, Ankylosing Spondylitis, and non-radiographic axial spondyloarthritis; applies to members when approval criteria are met and no exclusions to therapy exist.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyTaltz (ixekizumab) — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo significant changes

Effective DateN/A

Next Review DateN/A

Key ActionSubmit prior authorization with chart notes documenting affected area/BSA and prior medication trials or reasons to avoid them.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

12 monthstypical authorization duration

≥6min age for PsO

6 monthsTB testing window

Prior biologic/tsprior therapy often required

Coverage and Clinical Criteria

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.

Plaque psoriasis (PsO) — Initial therapy

Authorization of 12 months may be granted for members ≥6 years when ANY of the following are met:

PsO initial criteria: Member meets at least one of: (a) Crucial body areas affected (hands, feet, face, neck, scalp, genitals/groin, intertriginous areas); (b) At least 10% of body surface area (BSA) is affected; (c) At least 3% BSA affected AND either the member has a clinical reason to avoid methotrexate, cyclosporine, and acitretin, OR the member has had inadequate response or intolerance to phototherapy (e.g., UVB, PUVA) or to methotrexate, cyclosporine, or acitretin.see text