EUCRISA (crisaborole)
Self-Administration – topical
Diagnosis considered for coverage:
- Indicated for topical treatment of mild to moderate atopic dermatitis in adult and pediatric patients 3 months of age and older
Coverage Criteria:
For diagnosis of atopic dermatitis:
- Patient meets one of the following:
- Trial and failure (of a minimum 30 day supply), contraindication, or intolerance to one prescription strength topical corticosteroid, unless the affected area is sensitive (i.e., face, axillae, groin), OR
- Trial and failure (of a minimum 30 day supply) or intolerance to one generic topical calcineurin inhibitor (e.g., tacrolimus ointment), unless the patient is not a candidate for therapy (e.g., immunocompromised)
Coverage Duration:
- 12 months
Authorization is not covered for the following:
The use of this drug for indications not listed in this policy does not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics (P&T) Committee.
Additional Information:
- Recommended dose: Apply a thin layer of Eucrisa twice daily to affected areas
- Eucrisa is for topical use only and not for ophthalmic, oral, or intravaginal use
- Eucrisa is available as a 60 gram tube and 100 gram tube
Policy Updates:
- 3/20/2019 – New policy approved by P&T.
- 8/4/2020 – Criteria updated to reflect updated indication to include ages 3 months and older. Also updated wording for trial and failure of topical calcineurin inhibitor to ages 2 years of age and older to remain consistent with Elidel and Protopic indications
- 6/1/2023 – Criteria updated due to class review for topical atopic dermatitis agents
References:
- Ference JD, Last AR. Choosing Topical Corticosteroids. Am Fam Physician. 2009 Jan 15;79 (2):135-40.
- Eucrisa Prescribing Information. Pfizer, Inc. New York, NY. April 2020.
- Lexi-Comp Online [internet database]. Hudson, OH. Lexi-Comp, Inc. Updated periodically. Available by subscription at: http://online.lexi.com/. Accessed January 4, 2021.
- Protopic Prescribing Information. Leo Pharma Inc. Madison, NJ. February 2019.
Last review date: June 1, 2023