CurrentUnitedHealthcarePolicy 2025 P 2126-15

Siliq (brodalumab) prior authorization and medical necessity

Defines UnitedHealthcare prior authorization and medical necessity criteria for Siliq (brodalumab) for treatment of moderate to severe plaque psoriasis in adults; applies to providers requesting coverage under UnitedHealthcare benefit plans.

Policy Summary

PayerUnitedHealthcare

PolicySiliq (brodalumab) prior authorization and medical necessity

Policy CodePolicy 2025 P 2126-15

Change TypeRevised preferred product list and step therapy wording

Effective DateJun 1, 2025

Next Review Date

Key ActionObtain prior authorization; approvals are issued for 12 months when required documentation and step therapy criteria are met.

SourceLink

POLICY UPDATE CHANGES

Removed examples for adalimumab in step therapy and changed Stelara step therapy wording to 'One of the preferred ustekinumab products'.

Added Sotyktu as a step therapy agent and moved Cosentyx to preferred step agent while changing step requirement to three agents.

For a list of preferred products referenced in step therapy, the policy now refers users to drug coverage tools.

12 monthsauthorization duration

3required failed preferred agents

>=3% BSAdisease severity threshold

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Coverage criteria and exclusions

Initial Therapy — Covered when ALL of the following are met:

Covered when ALL of the following are met:

Overall: All criteria must be satisfied for approval

Documentation: Submission of medical records (e.g., chart notes, laboratory values, prescription claims history) documenting diagnosis of chronic moderate to severe plaque psoriasis

Disease severity and topical therapy: One of the following disease severity pathways must be met

Disease pathways: Either: (i) clinical severity with topical and methotrexate trials OR (ii) prior treatment with a targeted immunomodulator

Pathway i - clinical severity: All of the following: >=3% body surface area involvement OR palmoplantar, facial, genital involvement, or severe scalp psoriasis; AND history of failure to one specified topical therapy (document drug, date, duration); AND history of failure to a 3-month trial of methotrexate at maximally indicated dose unless contraindicated or intolerant (document drug, date, duration)>=3% BSA

Topical examples: corticosteroids, vitamin D analogs, tazarotene, calcineurin inhibitors, anthralin, coal tar

Pathway ii - prior targeted immunomodulator: Prior treatment with a targeted immunomodulator FDA‑approved for plaque psoriasis documented by claims or medical records (document drug, date, duration)

Examples: certolizumab, adalimumab, apremilast, risankizumab, ustekinumab, guselkumab, etanercept

Preferred agent step: History of failure, contraindication, or intolerance to three preferred products (document drug, date, and duration)3 agents

Preferred products listed in policy (see drug coverage tools for current list)

No combination therapy: Patient is not receiving Siliq in combination with another targeted immunomodulator

Combination with other targeted immunomodulators is not allowed

Prescriber: Prescribed by or in consultation with a dermatologist

Siliq (brodalumab) is excluded from coverage for the majority of UnitedHealthcare benefits. Providers should confirm member-specific benefit limitations and state mandates before submitting requests, as supply limits may be in place that affect coverage and quantity dispensed.

Use of Siliq in combination with another targeted immunomodulator is not allowed under the policy. Requests that propose concurrent use of Siliq plus another targeted immunomodulator will be denied as not meeting the coverage criteria.

Clinical thresholds and coding details

Body surface area threshold

Body surface area threshold>= 3% body surface area involvement

Special-site involvementPalmoplantar, facial, genital involvement, or severe scalp psoriasis

Context for thresholdRequired as part of documented moderate to severe plaque psoriasis for Siliq prior authorization

Authorization, documentation, and step therapy requirements

Prior Authorization

Prior Authorization Required

Prior authorization required. Approval will be issued for 12 months when documentation and step therapy criteria are met. State mandates, federal requirements, and member-specific benefit plans may affect coverage. Supply limits may apply.

Prior authorization duration: 12 months
State mandates and member benefit plans may impact coverage
Supply limits may be in place

Documentation Required

Required clinical documentation

Submit medical records (e.g., chart notes, laboratory values, prescription claims history) documenting the diagnosis and prior therapies. Failure to provide required medical records may result in denial.

Document diagnosis of chronic moderate to severe plaque psoriasis

Drug background and indications

Siliq (brodalumab) is a human interleukin-17 receptor A (IL-17RA antagonist) indicated for adults with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy. Coverage under UnitedHealthcare requires documentation of chronic moderate to severe plaque psoriasis, disease severity (for example, ≥3% body surface area or special-site involvement), prior topical and systemic therapy trials or prior targeted immunomodulator treatment as specified in the criteria, and adherence to step-therapy requirements when applicable.

Key definitions

Siliq (brodalumab)

DrugSiliq (brodalumab)

Mechanism of actionHuman interleukin-17 receptor A (IL-17RA) antagonist

IndicationTreatment of moderate to severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy and have failed or lost response to other systemic therapies

Disease severity

Definition (severity)>= 3% body surface area involvement

Special-site criteriaInvolvement of palmoplantar, facial, genital areas, or severe scalp psoriasis

Associated documentation