TWYNEO (tretinoin and benzoyl peroxide)

TWYNEO (tretinoin and benzoyl peroxide) cream 0.1%-3%

Self Administered - topical

Diagnosis considered for coverage:

• Acne Vulgaris - Indicated for the topical treatment of acne vulgaris in adults and pediatric patients 9 years of age and older.

Coverage Criteria:

• Patient is being treated for acne vulgaris as confirmed by medical records; AND
• Patient is 9 year of age or older; AND
• Medical records document a trial and failure, intolerance, or contraindication to one of the following:
  • generic clindamycin phosphate-benzoyl peroxide external gel (Duac 1-5%, Acanya 1.2-2.5%, or Neuac 1.2-5%)
  • generic benzoyl peroxide-erythromycin external gel (Benzamycin 5-3%)
  • Onexton (clindamycin phosphate-benzoyl peroxide gel 1.2-3.75%)
• Medical records document a trial and failure, intolerance, or contraindication to generic adapalene-benzoyl peroxide gel (Epiduo 0.1-2.5%, Epiduo Forte 0.3-2.5%)

Coverage Duration:

• One year

Authorization is not covered for the following:

• The following conditions, and other uses of this drug for indications not listed in this policy, do not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics Committee.
  • Cosmetic use (e.g., wrinkles, hyperpigmentation, etc.)

Additional Information:

• Acne vulgaris is an inflammatory disorder of the pilosebaceous unit (hair follicles and their accompanying sebaceous gland), which runs a chronic course and it is self-limiting. Acne vulgaris is triggered by Cutibacterium acnes in adolescence, under the influence of normal circulating dehydroepiandrosterone (DHEA). It is a very common skin disorder which can present with inflammatory and non-inflammatory lesions chiefly on the face but can also occur on the upper arms, trunk, and back.

Policy Updates:

• 08/16/2022 – New policy approved by P&T.

References:

1. Kolli SS, Pecone D, Pona A, et al. Topical Retinoids in Acne Vulgaris: A Systematic Review. Am J Clin Dermatol. 2019;20(3):345-365.
2. Stuart B, Maund E, Wilcox C, et al. Topical preparations for the treatment of mild-to-moderate acne vulgaris: systematic review and network meta-analysis. Br J Dermatol. 2021;185(3):512-525.
3. Thiboutot DM, Dreno B, Abanmi A, et al. Practical management of acne for clinicians: An international consensus from the Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol. 2018;78(2 Suppl 1):S1-S23.e1.
4. Twyneo Prescribing Information. Sol-Gel Technologies, Inc. December 2021.
5. Zaenglein AL, Pathy AL, Schlosser BJ, et al. American Academy of Dermatology guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-73.e33.