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Nemluvio (nemolizumab-ilto) — Blue Cross Blue Shield of New Mexico

Moderate-to-severe atopic dermatitis

Reauthorization criteria

  • Patient previously approved for the requested agent through the plan’s Prior Authorization process
  • Patient has had clinical benefit with the requested agent
  • If diagnosis is moderate-to-severe atopic dermatitis then ALL of the following:
  • A. Patient will continue standard maintenance therapies (e.g., topical emollients, good skin care practices) in combination with the requested agent
  • B. ONE of the following:
  • 1. Patient will continue topical corticosteroid OR topical calcineurin inhibitor therapy in combination with the requested agent OR
  • 2. Patient has been treated with the requested agent for at least 16 consecutive weeks AND BOTH of the following:
  • A. 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. Patient has an intolerance, hypersensitivity, or FDA labeled contraindication to ALL topical corticosteroids AND topical calcineurin inhibitors
  • C. ONE of the following:
  • 1. Patient is initiating therapy with the requested agent OR
  • 2. Patient has been treated with the requested agent for less than 16 consecutive weeks OR
  • 3. Patient has been treated with the requested agent for at least 16 consecutive weeks AND ONE of the following:
  • A. Requested dose is 30 mg every 8 weeks OR
  • B. Requested dose is 30 mg every 4 weeks AND ONE of the following:
  • 1. 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
  • Prescriber is a specialist in the area of the patient’s diagnosis (e.g., allergist, dermatologist, immunologist) OR has consulted with such a specialist
  • ONE of the following:
  • A. 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. Patient will be using the requested agent in combination with another immunomodulatory agent AND BOTH of the following:
  • 1. 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 (clinical trials, phase III studies, or guidelines submitted)
  • Patient does NOT have any FDA labeled contraindications to the requested agent

Approval duration

12 months