Otezla

Drug - Otezla® (apremilast) [Celgene Corporation]

September 2019

Therapeutic area - Auto-inflammatory diseases

Approval criteria

• Patient is at least 18 years of age AND
• Patient has oral ulcers associated with Behçet’s Disease AND
• Otezla is prescribed by a dermatologist AND
• Patient has tried colchicine at maximum tolerated dose for at least 3 months, unless contraindicated

OR

• Refer to the PA criteria, “Immunomodulators,” if patient has one of the following diagnoses:
  • Psoriatic arthritis OR
  • Plaque psoriasis

Quantity limit

Quantity limits are based on creatinine clearance calculated by the Cockcroft-Gault equation and must be provided at time of request

• CrCl ≥ 30 mL per minute: 60 mg/day
• CrCl < 30 mL per minute: 30 mg/day

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411