Under some plans, including plans that use an open or closed formulary, Taclonex is subject to step-therapy. Aetna considers Taclonex to be medically necessary for those members who meet the following step-therapy criteria:
For Taclonex
A documented trial of one month concurrent use of both Tazorac AND topical betamethasone -alternatives on the Preferred Drug List.
If it is medically necessary for a member to be treated initially with a medication subject to step-therapy, the member's treating physician may contact the Aetna Pharmacy Management Precertification Unit to request coverage as a medical exception at 1-800-414-2386. (See criteria under section II below.)
Medical Exception Criteria
Dovonex and Taclonex are currently listed on the Aetna Formulary Exclusions List.* Therefore, they are excluded from coverage for members enrolled in prescription drug benefits plans that use a closed formulary, unless a medical exception is granted. Aetna considers Dovonex and Taclonex to be medically necessary for those members who meet any of the following criteria:
For Dovonex (A ORB)
A. A documented:
Contraindication to the preferred alternative Tazorac OR
Intolerance to the preferred alternative Tazorac OR
Allergy to the preferred alternative Tazorac OR
Failure of an adequate trial of one month of the preferred alternative Tazorac
Member is pregnant (Dovonex is a pregnancy Category C) OR
Member is using product on the scalp and needs a liquid preparation
OR
B. Member is documented to have been successfully treated with calcipotriene
(Dovonex) in the past.
For Taclonex
A. A documented:
Contraindication to the preferred alternative Tazorac OR
Intolerance to the preferred alternative Tazorac OR
Allergy to the preferred alternative Tazorac OR
Failure of one month concurrent use of both Tazorac AND topical betamethasone.
Place of Service:
Outpatient
The above policy is based on the following references:
Drug Facts and Comparisons on-line. (www.drugfacts.com), Wolters Kluwer Health, St. Louis, MO. 2006.
USP DI® Drug Information For The Health Care Professional - 26th Ed. (online from www.statref.com) Thomson Micromedex, Greenwood Village, CO. 2006 .
AHFS Drug Information® with AHFSfirstReleases®. (online from www.statref.com), American Society Of Health-System Pharmacists®, Bethesda, MD. 2006.
Lebwohl M. Advances in psoriasis therapy. Dermatol Clin. 2000;18(1):13-9.
Laborde SV and Scher RK. Developments in the treatment of nail psoriasis, melanonychia striata, and onychomycosis. Dermatol Clin. 2000;18(1):37-46.
Bruce S, Epinette WW, Funicella T, et al. Comparative study of calcipotriene ointment and fluocinonide ointment in the treatment of psoriasis. J Am Acad Dermatol 1994;31:755-9.
Guenther LC, Poulin YP, Pariser DM. A comparison of tazarotene 0.1% gel once daily plus mometasone furoate 0.1% cream once daily versus calcipotriene 0.005% ointment twice daily in the treatment of plaque psoriasis. Clin Ther 2000;22(10):1225-38.
Tanghetti EA. An observation study evaluating the treatment of plaque psoriasis with tazarotene gels, alone and with an emollient and/or corticosteroid. Cutis. 2000;66(Suppl 6):4-11.
Mason J, Mason AR, Cork MJ. Topical preparations for the treatment of psoriasis: a systematic review. Br J Dermatol. 2002;146:351-64.
Scher RK, Stiller M, Zhu YI. Tazarotene 0.1% gel in the treatment of fingernail psoriasis: a double-blind, randomized, vehicle-controlled study. Cutis 2001;68:355-8.
Lebwohl M, Drake L, Menter A, et al. Consensus conference: Acitretin in combination with UVB or PUVA in the treatment of psoriasis. J Am Acad Dermatol 2001;45:544-53.
Lebwohl M, Ali S. Treatment of psoriasis. Part 2. Systemic therapies. J Am Acad Dermatol 2001;45:649-61.
Lebwohl M, Ali S. Treatment of psoriasis. Part 1. Topical therapy and phototherapy. J Am Acad Dermatol 2001;45:487-98.
Product Information Taclonex® ointment, Warner Chilcott Inc., Rockway, NJ January 2006.
van de Kerkhof PC, Wasel N, Kragballe K, Cambazard F, Murray S. A two-compound product containing calcipotriol and betamethasone dipropionate provides rapid, effective treatment of psoriasis vulgaris regardless of baseline disease severity. Dermatology. 2005;210(4):294-9.
Gladman DD. Traditional and newer therapeutic options for psoriatic arthritis: an evidence-based review. Drugs. 2005;65(9):1223-38.
Copyright Aetna Inc. All rights reserved. Pharmacy Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
*P = Preferred
FE = Formulary Excluded
NP = Nonpreferred
PR = Precertification
QL = Quantity Limits
AL = Age Limits
ST = Step-Therapy
‡M EX = Medical Exception
*The lists above are subject to change. Not all programs - for example step-therapy, precertification, and quantity limits - are available in all service areas.
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