IL-31 inhibitors — Blue Cross Blue Shield of Illinois

Reauthorization criteria

• The patient has been previously approved for the requested agent through the plan’s Prior Authorization process AND
• The patient has had clinical benefit with the requested agent AND
• If the patient has a diagnosis of moderate-to-severe atopic dermatitis, then ALL of the following: A. The patient will continue standard maintenance therapies (e.g., topical emollients, good skin care practices) in combination with the requested agent AND B. ONE of the following: 1. The patient will continue topical corticosteroid OR topical calcineurin inhibitor therapy in combination with the requested agent OR 2. The patient has been treated with the requested agent for at least 16 consecutive weeks AND BOTH of the following: A. The patient's atopic dermatitis has sufficiently improved AND B. Based on disease activity, concurrent topical therapies (e.g., topical corticosteroid, topical calcineurin inhibitor) have been tapered and discontinued OR 3. The patient has an intolerance, hypersensitivity, or FDA labeled contraindication to ALL topical corticosteroids AND topical calcineurin inhibitors AND C. ONE of the following: 1. The patient is initiating therapy with the requested agent OR 2. The patient has been treated with the requested agent for less than 16 consecutive weeks OR 3. The patient has been treated with the requested agent for at least 16 consecutive weeks AND ONE of the following: A. The requested dose is 30 mg every 8 weeks OR B. The requested dose is 30 mg every 4 weeks AND ONE of the following: 1. The patient has NOT achieved clear or almost clear skin OR 2. There is support for continued therapy at the requested dose of 30 mg every 4 weeks AND
• The prescriber is a specialist in the area of the patient’s diagnosis (e.g., allergist, dermatologist, immunologist), or the prescriber has consulted with a specialist in the area of the patient’s diagnosis AND
• ONE of the following: A. The patient will NOT be using the requested agent in combination with another immunomodulatory agent (e.g., TNF inhibitors, JAK inhibitors, IL-4 inhibitors) OR B. The patient will be using the requested agent in combination with another immunomodulatory agent AND BOTH of the following: 1. The prescribing information for the requested agent does NOT limit the use with another immunomodulatory agent AND 2. There is support for use of combination therapy (submitted copy of clinical trials, phase III studies, or guidelines required)
• The patient does NOT have any FDA labeled contraindications to the requested agent

Approval duration

12 months