Dupixent — CareFirst (Caremark)

Initial criteria

• Member age ≥ 18 years
• Diagnosis confirmed by direct immunofluorescence (DIF) study OR immune serological test(s) (e.g., indirect immunofluorescence microscopy, ELISA)
• Member has characteristic clinical features of bullous pemphigoid (e.g., urticarial, eczematous, or erythematous plaques; bullae; pruritus)
• Member has moderate to severe disease
• Member has had an inadequate treatment response with a super-high potency topical corticosteroid OR oral corticosteroid OR use of these is not advisable due to contraindications or prior intolerances

Reauthorization criteria

• Member age ≥ 18 years
• Member has achieved or maintained a positive clinical response as evidenced by low disease activity (absence of new or established lesions) OR reduction in pruritus intensity and improvement in extent and severity of lesions

Approval duration

Initial 12 months, Reauthorization 12 months