Apremilast Is an Oral Medication Used to Treat Plaque Psoriasis, Psoriatic Arthritis, and Oral Ulcers From Behcet's Disease

If your doctor has mentioned Apremilast — or you've seen it listed as Otezla — you probably have questions. What does it do? How do you take it? What does it cost? This guide covers everything you need to know about Apremilast in 2026, written in plain language.

What Is Apremilast?

Apremilast is the generic name for the brand-name drug Otezla (and the extended-release version, Otezla XR). It belongs to a class of medications called phosphodiesterase 4 (PDE4) inhibitors.

Here are the key facts:

• Manufacturer: Amgen Inc.
• FDA approval: First approved in 2014 for psoriatic arthritis, with subsequent approvals for plaque psoriasis (2014) and Behcet's disease oral ulcers (2019)
• Drug class: PDE4 inhibitor
• Form: Oral tablets (10 mg, 20 mg, 30 mg) and extended-release tablets (75 mg)
• Controlled substance: No — Apremilast is not a controlled substance

Unlike biologic medications that require injections or infusions, Apremilast is a pill you take by mouth. This makes it an attractive option for people who want an effective systemic treatment without needles. For a deeper look at how it works in your body, see our article on how Apremilast works.

What Is Apremilast Used For?

Apremilast is FDA-approved to treat:

1. Plaque Psoriasis

Apremilast is approved for adults with moderate-to-severe plaque psoriasis who are candidates for phototherapy (light therapy) or systemic therapy. It's also approved for pediatric patients weighing at least 20 kg (44 lbs). Plaque psoriasis causes raised, red, scaly patches on the skin — and Apremilast helps by reducing the inflammation that drives these symptoms.

2. Psoriatic Arthritis

For adults with active psoriatic arthritis, Apremilast can help reduce joint pain, swelling, and stiffness. It can be used alone or in combination with other disease-modifying antirheumatic drugs (DMARDs).

3. Behcet's Disease (Oral Ulcers)

Apremilast is the first and only FDA-approved treatment specifically for oral ulcers associated with Behcet's disease in adults.

Off-Label Uses

Some doctors prescribe Apremilast off-label for other inflammatory conditions, including atopic dermatitis, lichen planus, hidradenitis suppurativa, and alopecia areata. Off-label means the FDA hasn't specifically approved it for these uses, but there may be clinical evidence supporting its effectiveness.

How Is Apremilast Taken?

Apremilast comes in two formulations:

Standard Otezla (30 mg Twice Daily)

The standard version uses a 5-day starter pack to gradually increase your dose and reduce stomach-related side effects:

1. Day 1: 10 mg in the morning
2. Day 2: 10 mg morning + 10 mg evening
3. Day 3: 10 mg morning + 20 mg evening
4. Day 4: 20 mg morning + 20 mg evening
5. Day 5: 20 mg morning + 30 mg evening
6. Day 6 and beyond: 30 mg morning + 30 mg evening

This titration schedule helps minimize the diarrhea, nausea, and other GI side effects that can happen when you start the medication.

Otezla XR (75 mg Once Daily)

The extended-release version is taken once daily and does not require a titration period. The tablet is designed to release the medication slowly throughout the day.

Important Instructions

• Tablets can be taken with or without food
• Swallow tablets whole — do not crush, split, or chew them
• Try to take your doses at roughly the same times each day
• If you have severe kidney problems (creatinine clearance less than 30 mL/min), your doctor will reduce your dose to 30 mg once daily

Who Should Not Take Apremilast?

Apremilast is contraindicated (should not be used) if you have a known allergy to Apremilast or any of the inactive ingredients in the tablet.

Your doctor should also carefully consider whether Apremilast is right for you if:

• You have a history of depression or suicidal thoughts — Apremilast carries a warning about potential mood changes. Read more about this in our side effects guide.
• You are pregnant or planning to become pregnant — animal studies showed risks, and there's limited human data
• You are breastfeeding — it's unknown if Apremilast passes into breast milk
• You take strong CYP450 inducers like Rifampin, Carbamazepine, Phenytoin, or Phenobarbital — these drugs can reduce Apremilast's effectiveness by up to 72%. See our drug interactions guide for details.

How Much Does Apremilast Cost?

Without insurance, Apremilast costs approximately $5,000 to $6,800 for a 30-day supply (60 tablets of 30 mg). There is currently no generic version available in the United States — although generic Apremilast has been approved by the FDA, patent litigation has delayed its commercial launch until approximately 2028-2029.

Here's how to bring the cost down:

• Amgen SupportPlus Co-Pay Program: Eligible commercially insured patients may pay as little as $0 copay
• Bridge to Commercial Coverage: Free Otezla for up to 12 fills while your prior authorization is being processed
• Amgen Safety Net Foundation: Provides Otezla at no cost to qualifying uninsured or underinsured patients
• Insurance: Most commercial plans and Medicare Part D cover Apremilast, though prior authorization and step therapy are common requirements

For a complete breakdown of savings options, see our guide on how to save money on Apremilast.

How Effective Is Apremilast?

In clinical trials for plaque psoriasis, about 33% of patients achieved a 75% improvement in their psoriasis severity score (PASI 75) at 16 weeks, compared to about 5% with placebo. While this is lower than some biologic medications, Apremilast offers the convenience of an oral tablet with a relatively mild side effect profile.

For psoriatic arthritis, patients showed significant improvement in joint tenderness, swelling, and physical function compared to placebo.

Results vary — some patients see dramatic improvement, while others may respond better to alternative treatments.

Final Thoughts

Apremilast is a well-established oral treatment option for psoriasis, psoriatic arthritis, and Behcet's disease. It offers a needle-free alternative to biologics, has a manageable side effect profile, and comes with strong manufacturer support programs to help with cost.

If you think Apremilast might be right for you, talk to a dermatologist or rheumatologist about whether it fits your treatment plan. And when you're ready to fill your prescription, Medfinder can help you find a pharmacy with Apremilast in stock.