Dupixent (dupilumab) — CareFirst (Caremark)
chronic rhinosinusitis with nasal polyps (CRSwNP)
Preferred products
- Nucala
- Xolair
Initial criteria
- Member age ≥ 12 years
- Authorization of 6 months may be granted for members who have previously received a biologic (e.g., Nucala, Xolair) indicated for CRSwNP in the past year
- Bilateral nasal polyposis and chronic sinusitis symptoms present despite intranasal corticosteroid treatment for ≥4 weeks unless contraindicated or not tolerated
- CRSwNP persists despite one of the following: prior sino-nasal surgery OR prior systemic corticosteroid treatment within the last 2 years was ineffective, unless contraindicated or not tolerated
Reauthorization criteria
- Positive clinical response documented in chart notes or medical records
Approval duration
6 months