Tildrakizumab-asmn

This policy covers tildrakizumab-asmn (Ilumya) for treatment of moderate-to-severe plaque psoriasis in adults (≥18) who are candidates for systemic therapy or phototherapy, with documented disease severity (e.g., PASI ≥12, PGA ≥3, or BSA ≥10%) using the FDA‑label dosing of 100 mg at Week 0, Week 4, then every 12 weeks. Coverage is limited to FDA‑labeled indications and uses supported by HHS‑adopted compendia or two qualifying peer‑reviewed articles for off‑label use, excludes pediatric and non‑plaque psoriasis subtypes, and is subject to member benefit plan, state regulatory, and formulary restrictions (as specified for HCSC Ohio members).

"Coverage of FDA-approved drugs when prescribed for a use recognized as safe and effective in one or more standard medical reference compendia adopted by the U."

Sign up to see full coverage criteria, indications, and limitations.