Dupixent — Blue Cross Blue Shield of Montana

Initial criteria

• The patient has eosinophilic type asthma AND meets ONE of: baseline blood eosinophil count ≥150 cells/µL, FeNO ≥20 ppb, or sputum eosinophils ≥2%, all measured while on high-dose inhaled or daily oral corticosteroids; OR the patient has oral corticosteroid-dependent type asthma.
• The patient has a history of uncontrolled asthma while on asthma control therapy as shown by ONE of: ≥2 courses of systemic corticosteroids in the past 12 months, serious exacerbation requiring hospitalization/mechanical ventilation/ER or urgent care visit in the past 12 months, controlled asthma that worsens during corticosteroid taper, or FEV1 <80% predicted.