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