Dupixent (dupilumab) — CareFirst (Caremark)
moderate-to-severe asthma
Preferred products
- Nucala
- Cinqair
Initial criteria
- Member age ≥ 6 years
- Authorization of 6 months may be granted for members who have previously received a biologic drug (e.g., Nucala, Cinqair) indicated for asthma in the past year
- Uncontrolled asthma demonstrated by at least one of the following within the past year: ≥2 exacerbations requiring oral or injectable corticosteroids, ≥1 exacerbation resulting in hospitalization or emergency medical visit, or poor symptom control (frequent symptoms, reliever use, limited activity, or night waking)
- EITHER baseline blood eosinophil count ≥ 150 cells/µL AND inadequate asthma control despite optimized medium-to-high-dose inhaled corticosteroid plus an additional controller (LABA, LAMA, leukotriene modifier, or sustained-release theophylline) OR inadequate asthma control despite high-dose inhaled corticosteroid, additional controller, and oral glucocorticoids (≥5 mg/day prednisone equivalent, for most days during previous 6 months)
- Member will continue maintenance asthma treatments (inhaled corticosteroid and additional controller) in combination with requested medication
Reauthorization criteria
- Improvement in asthma control demonstrated by chart notes or documentation
Approval duration
6 months