Cibinqo — CareFirst (Caremark)

moderate-to-severe atopic dermatitis

Preferred products

Member age ≥ 12 years
Medication prescribed by or in consultation with a dermatologist or allergist/immunologist
Affected body surface area ≥ 10% OR crucial body areas (hands, feet, face, neck, scalp, genitals/groin, intertriginous areas) affected
Member has had an inadequate treatment response within the past 180 days to one of the following: a high potency or super-high potency topical corticosteroid, topical calcineurin inhibitor, topical JAK inhibitor, or topical PDE-4 inhibitor; OR use of these agents is not advisable (due to contraindication, prior intolerance, or inappropriate potency for member’s age)
Member has had an inadequate response or intolerance to treatment with at least one biologic (e.g., Adbry, Dupixent, Ebglyss, Nemluvio) OR a systemic targeted synthetic drug (e.g., Rinvoq) indicated for the treatment of atopic dermatitis within the past 180 days
Member has a documented negative tuberculosis test (TST or IGRA) within 12 months of initiating therapy if naïve to biologic or targeted synthetic drugs associated with increased TB risk; if positive, further testing must confirm no active disease and latent TB must be treated before initiation
Requested medication will not be used concomitantly with another biologic, targeted synthetic drug, or potent immunosuppressant (e.g., azathioprine, cyclosporine)

Member age ≥ 12 years
Member continues to use medication for moderate-to-severe atopic dermatitis
Member has achieved or maintained positive clinical response as evidenced by low disease activity (clear or almost clear skin) or improvement in signs and symptoms (e.g., redness, itching, oozing/crusting)

Initial: 4 months; Reauthorization: 12 months