lu codes

Repeats within a 25 day period will not be reimbursed.

Therapy should be reassessed at 6 months.

1. Severe defined based on the Physician Global Assessment (PGA), including: - At least one of the following cardinal features present at baseline as moderate or severe: erythema, scaling, hyperkeratosis/lichenification; and - one of the following features present as severe: vesiculation, edema, fissures, pruritus/pain; and - with an area of greater than 30% of affected hand surface 2. Chronic defined as: - persists for greater than 3 months; OR - reoccurs greater than or equal to 2 times within 12 months

Claims for the first 6 months must be written by a dermatologist. Monitoring of patients is required to determine if continuation of therapy beyond 12 weeks is required. Patients not responding adequately at 12 weeks should have treatment discontinued. The recommended dose for Cosentyx is 300mg subcutaneously at weeks 0, 1, 2 and 3, and then monthly starting at week 4. A maintenance dose of 300mg every 2 weeks may be considered for adult patients with a body weight of 90kg or higher. If the patient has not responded adequately after 12 weeks of treatment at the Health Canada approved doses, higher doses are not recommended and the physician should consider switching to an alternative biologic agent. Note 1: Definition of severe plaque psoriasis: - Body Surface Area (BSA) involvement of at least 10%, or involvement of the face, hands, feet or genital regions, AND - Psoriasis Area and Severity Index (PASI) score of at least 10 (not required if there is involvement of the face, hands, feet or genital regions), AND - Dermatology Life Quality Index (DLQI) score of at least 10. Note 2: Definition of failure, intolerance or contraindication to adequate trials of standard therapies: - 6 month trial of at least 3 topical agents including vitamin D analogues and steroids, AND - 12 week trial of phototherapy (unless not accessible), AND - 6 month trial of at least 2 systemic, oral agents used alone or in combination - Methotrexate 15-30mg per week - Acitretin (could have been used with phototherapy) - Cyclosporine Maintenance/Renewal: After 3 months of therapy, patients who respond to therapy should have: - At least a 50% reduction in PASI, AND - at least a 50% reduction in BSA involvement, AND - at least a 5 point reduction in DLQI score

Claims for the first 6 months must be written by a dermatologist. Monitoring of patients is required to determine if continuation of therapy beyond 12 weeks is required. Patients not responding adequately at 12 weeks should have treatment discontinued. Approvals will only allow for standard dosing for Taltz 160mg at week 0, followed by 80mg subcutaneously at weeks 2, 4, 6, 8, 10, and 12, and then 80mg every 4 weeks. If the patient has not responded adequately after 12 weeks of treatment at the Health Canada approved dose, higher doses are not recommended and the physician should consider switching to an alternative biologic agent. Note 1: Definiton of severe plaque psoriasis: - Body Surface Area (BSA) involvement of at least 10%, or involvement of the face, hands, feet or genital regions, AND - Psoriasis Area and Severity Index (PASI) score of at least 10 (not required if there is involvement of the face, hands, feet or genital regions), AND - Dermatology Life Quality Index (DLQI) score of at least 10. Note 2: Definition of failure, intolerance or contraindication to adequate trials of standard therapies: - 6 month trial of at least 3 topical agents including vitamin D analogues and steroids, AND - 12 week trial of phototherapy (unless not accessible), AND - 6 month trial of at least 2 systemic, oral agents used alone or in combination - Methotrexate 15-30mg per week - Acitretin (could have been used with phototherapy) - Cyclosporine Maintenance/Renewal: After 3 months of therapy, patients who respond to therapy should have: - at least 50% reduction in PASI, AND - at least 50% reduction in BSA involvement, AND - at least a 5 point reduction in DLQI score

Claims for the first 6 months must be written by a dermatologist. Monitoring of patients is required to determine if continuation of therapy beyond 12 weeks is required. Patients not responding adequately at 12 weeks should have treatment discontinued. Approvals will only allow for standard dosing for Siliq 210mg subcutaneously at weeks 0, 1 and 2, and then every 2 weeks. If the patient has not responded adequately after 12 weeks of treatment at the Health Canada approved dose, higher doses are not recommended and the physician should consider switching to an alternative biologic agent. Note 1: Definition of severe plaque psoriasis: - Body Surface Area (BSA) involvement of at least 10%, or involvement of the face, hands, feet or genital regions, AND - Psoriasis Area and Severity Index (PASI) score of at least 10 (not required if there is involvement of the face, hands, feet or genital regions), AND - Dermatology Life Quality Index (DLQI) score of at least 10. Note 2: Definition of failure, intolerance or contraindication to adequate trials of standard therapies: - 6 month trial of at least 3 topical agents including vitamin D analogues and steroids, AND - 12 week trial of phototherapy (unless not accessible), AND - 6 month trial of at least 2 systemic, oral agents used alone or in combination - Methotrexate 15-30mg per week - Acitretin (could have been used with phototherapy) - Cyclosporine Maintenance/Renewal: After 3 months of therapy, patients who respond to therapy should have: - at least 50% reduction in PASI, AND - at least 50% reduction in BSA involvement, AND - at least a 5 point reduction in DLQI score

Claims for the first 6 months must be written by a dermatologist. Monitoring of patients is required to determine if continuation of therapy beyond 12 weeks is required. Patients not responding adequately at 12 weeks should have treatment discontinued. Approvals will only allow for standard dosing for Skyrizi 150mg subcutaneously at weeks 0 and 4, and then every 12 weeks. If the patient has not responded adequately after 12 weeks of treatment at the Health Canada approved dose, higher doses are not recommended, and the physician should consider switching to an alternative biologic agent. Note 1: Definition of severe plaque psoriasis: - Body Surface Area (BSA) involvement of at least 10%, or involvement of the face, hands, feet or genital regions, AND - Psoriasis Area and Severity Index (PASI) score of at least 10 (not required if there is involvement of the face, hands, feet or genital regions), AND - Dermatology Life Quality Index (DLQI) score of at least 10. Note 2: Definition of failure, intolerance or contraindication to adequate trials of standard therapies: - 6 month trial of at least 3 topical agents including vitamin D analogues and steroids, AND - 12 week trial of phototherapy (unless not accessible), AND - 6 month trial of at least 2 systemic, oral agents used alone or in combination - Methotrexate 15-30mg per week - Acitretin (could have been used with phototherapy) - Cyclosporine Maintenance/Renewal: After 3 months of therapy, patients who respond to therapy should have: - at least 50% reduction in PASI, AND - at least 50% reduction in BSA involvement, AND - at least a 5 point reduction in DLQI score.

Claims for the first 6 months must be written by a dermatologist. Monitoring of patients is required to determine if continuation of therapy beyond 12 weeks is required. Patients not responding adequately at 12 weeks should have treatment discontinued. Approvals will only allow for standard dosing for Ilumya 100mg subcutaneously at weeks 0 and 4, and then every 12 weeks. Ilumya should not be used in combination with other systemic or biologic treatments for severe plaque psoriasis. If the patient has not responded adequately after 12 weeks of treatment at the Health Canada approved dose, higher doses are not recommended, and the physician should consider switching to an alternative biologic agent. Note 1: Definition of severe plaque psoriasis: - Body Surface Area (BSA) involvement of at least 10%, or involvement of the face, hands, feet or genital regions, AND - Psoriasis Area and Severity Index (PASI) score of at least 10 (not required if there is involvement of the face, hands, feet or genital regions), AND - Dermatology Life Quality Index (DLQI) score of at least 10. Note 2: Definition of failure, intolerance or contraindication to adequate trials of standard therapies: - 6 month trial of at least 3 topical agents including vitamin D analogues and steroids, AND - 12 week trial of phototherapy (unless not accessible), AND - 6 month trial of at least 2 systemic, oral agents used alone or in combination - Methotrexate 15-30mg per week - Acitretin (could have been used with phototherapy) - Cyclosporine Maintenance/Renewal: After 3 months of therapy, patients who respond to therapy should have: - at least 75% reduction in PASI, AND - at least 50% reduction in BSA involvement, AND - at least a 5 point reduction in DLQI score.