Pharmacy Prior Authorization Criteria

Sotyktu (deucravacitinib)

Indications for Prior Authorization

Sotyktu (deucravacitinib)

• For diagnosis of Plaque Psoriasis (PsO)
  Indicated for the treatment of moderate-to-severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy.

  Limitations of Use: Sotyktu is not recommended for use in combination with other potent immunosuppressants.

Criteria

Sotyktu

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)
For diagnosis of Plaque Psoriasis

• Diagnosis of moderate to severe plaque psoriasis
AND
• One of the following [2]:
• At least 3% body surface area (BSA) involvement
• Severe scalp psoriasis
• Palmoplantar (i.e., palms, soles), facial, or genital involvement
AND
• Minimum duration of a 4-week trial and failure, contraindication, or intolerance to one of the following topical therapies [3]:
• corticosteroids (e.g., betamethasone, clobetasol)
• vitamin D analogs (e.g., calcitriol, calcipotriene)
• tazarotene
• calcineurin inhibitors (e.g., tacrolimus, pimecrolimus)
AND
• Prescribed by or in consultation with a dermatologist
AND
• Not used in combination with other potent immunosuppressants (e.g., azathioprine, cyclosporine, biologic disease-modifying antirheumatic drugs [DMARDs])

Sotyktu

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)
For diagnosis of Plaque Psoriasis

• Patient demonstrates positive clinical response to therapy as evidenced by ONE of the following [1-3]:
• Reduction in the body surface area (BSA) involvement from baseline
• Improvement in symptoms (e.g., pruritus, inflammation) from baseline
AND
• Not used in combination with other potent immunosuppressants (e.g., azathioprine, cyclosporine, biologic DMARDs)

P & T Revisions

2024-12-11, 2024-09-15, 2024-06-24, 2024-05-31, 2024-04-24, 2024-03-07, 2024-02-01, 2023-11-02, 2023-06-30, 2023-03-02, 2023-02-12, 2023-02-01, 2022-11-20

References

1. Sotyktu Prescribing Information. Bristol-Myers Squibb Co. Princeton, NJ. September 2022.
2. Menter A, Strober BE, Kaplan DH, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol 2019;80:1029-72.
3. Elmets CA, Korman NJ, Farley Prater E, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol 2021;84:432-70.

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Revision History

• 2024-12-11: Removed step through TIMS agents
• 2024-09-15: Removed anthralin and coal tar as topical step options for PsO
• 2024-06-24: No criteria changes; updated background table to specify BI manufacturer for adalimumab-adbm
• 2024-05-31: Updated background table to include CalPERS formulary; no criteria changes
• 2024-04-24: Updated verbiage in the step to say, "One formulary adalimumab product manufactured by AbbVie, Amgen, BI, or Sandoz"; added table to background section detailing preferred adalimumab products
• 2024-03-07: Updated verbiage in the step to say, "One formulary adalimumab product manufactured by AbbVie, Amgen, BI, or Sandoz"; added table to background section detailing preferred adalimumab products
• 2024-02-01: Removed trial of Taltz; added Otezla as an additional preferred alternative; removed paid claims and records requirements, steps from reauth criteria, and drug-specific nonformulary criteria
• 2023-11-02: Annual review - update reauth verbiage to "Patient demonstrates..."
• 2023-06-30: Addition of Cyltezo, Hyrimoz, and brand Adalimumab-adaz as preferred step options
• 2023-03-02: Step requirements added to reauth criteria; NF criteria section added
• 2023-02-12: Addition of records/claims requirements for steps, and addition of biologic DMARDs as an example of potent immunosuppressants
• 2023-02-01: Addition of Amjevita as another preferred step option
• 2022-11-20: New program

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