dupilumab — Blue Cross Blue Shield of Montana

Initial criteria

• Patient has at least TWO of: nasal discharge (rhinorrhea or post-nasal drainage), nasal obstruction or congestion, loss or decreased sense of smell, facial pressure or pain.
• Symptoms present for at least 12 consecutive weeks.
• Diagnosis confirmed by anterior rhinoscopy or endoscopy OR CT of the sinuses.
• Patient has tried and had inadequate response, intolerance, or contraindication to ONE intranasal corticosteroid therapy (e.g., fluticasone, mometasone, Sinuva) after ≥4-week duration of therapy.