July 6, 2020
VDP routinely updates existing clinical prior authorization criteria to reflect recent FDA-approved indications or safety information from the product package insert, and will revise the Eucrisa (crisaborole) criteria within the Topical Immunomodulators clinical prior authorization on Aug. 24, 2020:
- Previously, Eucrisa was indicated for children 2 years of age and older. Recently, Eucrisa had an age extension for the treatment of mild to moderate topical dermatitis for children age 3 months and older.
- Revised criteria will acknowledge this age change to allow children less than 2 years of age to receive Eucrisa without the requirement for a trial of a topical steroid
Refer to page 32 of the criteria guide (PDF) for more information.
This prior authorization is optional for Medicaid managed care. The Pharmacy Clinical Prior Authorization Assistance Chart (PDF) shows the prior authorization that each 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.
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