Dupixent (dupilumab) — CareFirst (Caremark)
moderate-to-severe atopic dermatitis
Preferred products
- Adbry
- Ebglyss
- Nemluvio
- Cibinqo
- Rinvoq
Initial criteria
- Member age ≥ 6 months
- Authorization of 4 months may be granted for members who have previously received a biologic (e.g., Adbry, Ebglyss, Nemluvio) or systemic targeted synthetic drug (e.g., Cibinqo, Rinvoq) indicated for moderate-to-severe atopic dermatitis in the past year
- Affected body surface area ≥ 10% OR crucial body areas (hands, feet, face, neck, scalp, genitals/groin, intertriginous areas) are affected
- Member has had inadequate treatment response with a medium to super-high potency topical corticosteroid, topical calcineurin inhibitor, topical JAK inhibitor, or topical PDE-4 inhibitor in the past year OR these therapies are not advisable due to contraindication or prior intolerance
Reauthorization criteria
- Positive clinical response demonstrated by chart notes or medical record documentation
Approval duration
4 months