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Clinical Prior Authorization Update for Topical Immunomodulators Scheduled for August 24, 2020

Last updated on 7/24/2020

Information posted July 24, 2020

The Vendor Drug Program (VDP) routinely updates existing clinical prior authorization criteria to reflect recent U.S. Food and Drug Administration (FDA)-approved indications or safety information from the product package insert, and will revise the the Eucrisa (crisaborole) criteria within the Topical Immunomodulators clinical prior authorization on August 24, 2020:

  • Previously, Eucrisa was indicated for children who are two years of age and older. Recently, Eucrisa had an age extension for the treatment of mild to moderate topical dermatitis for children who are 3 months of age and older.
  • Revised criteria will acknowledge this age change to allow children who are one year of age and younger to receive Eucrisa without the requirement for a trial of a topical steroid.This prior authorization is optional for Medicaid managed care. The Pharmacy Clinical Prior Authorization Assistance Chart shows the prior authorization that each managed care organization (MCO) uses and how they relate to the authorizations used for traditional Medicaid claims processing. This chart is updated quarterly and will be revised again in November. Providers can also refer to the VDP MCO Resources for links to each MCO's clinical prior authorizations.

Refer to page 32 of the criteria guide for more information.

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