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CommercialPrior AuthMedium impact

Otezla (apremilast)

Blue Cross & Blue Shield of Mississippi·MS · Dermatology, Rheumatology·Medical Policy
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

Summary

This is a new prior authorization policy for Otezla (apremilast) and Otezla XR for treating psoriatic arthritis, plaque psoriasis, and Behçet's disease. Prior authorization is required for all patients, with specific criteria including trial of conventional therapy, specialist prescriber requirement, and quantity limits based on strength and formulation.

Action Required

Action needed
Immediately: Update billing system to flag Otezla (apremilast) and Otezla XR prescriptions for prior authorization requirement. Train staff to verify BCBSMS prior auth before dispensing. Ensure dermatology and rheumatology providers are aware of the specialist prescriber requirement and documentation needs for psoriatic arthritis, plaque psoriasis, and Behçet's disease patients. Claims will be denied without proper prior authorization.

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