nemolizumab-ilto — Blue Cross Blue Shield of Kansas

Initial criteria

• The patient has a diagnosis of prurigo nodularis (PN).
• The patient has ALL of the following features associated with PN:
• • Presence of ≥ 20 firm, nodular lesions AND
• • Pruritus that has lasted for at least 6 weeks AND
• • History and/or signs of repeated scratching, picking, or rubbing