Dupixent — CareFirst (Caremark)

Initial criteria

• Member age ≥ 18 years
• Diagnosis confirmed by spirometry showing FEV₁/FVC < 0.7 post-bronchodilation
• Member demonstrates classic signs or symptoms of COPD (e.g., dyspnea, wheezing, chest tightness, fatigue, activity limitation, cough with or without sputum production, chronic bronchitis)
• Absolute blood eosinophil count ≥ 300 cells/µL prior to initiating therapy
• Inadequately controlled COPD evidenced by ≥ 2 moderate exacerbations requiring systemic glucocorticoids/antibiotics or ≥ 1 severe exacerbation requiring hospitalization/emergency care in the last year
• Member is currently receiving maintenance inhaled triple therapy (ICS + LAMA + LABA) OR receiving LAMA + LABA and has a contraindication to ICS
• Member will continue maintenance COPD treatments (e.g., ICS/LAMA/LABA combinations) with the requested medication

Reauthorization criteria

• Member age ≥ 18 years
• Member has achieved or maintained a positive clinical response as evidenced by improvement in signs and symptoms of COPD (e.g., decrease in exacerbations, improvement in pre-bronchodilator FEV₁) or stabilization of disease
• Member will continue maintenance COPD treatments (ICS with LAMA and LABA, or LAMA and LABA) in combination with the requested medication

Approval duration

Initial 12 months, Reauthorization 12 months