Dupixent — CareFirst (Caremark)

Initial criteria

• Authorization of 12 months may be granted for severe (G3) pruritus when no response to gabapentinoids in one month OR for use as additional therapy for severe (G3) or life-threatening (G4) bullous dermatitis

Reauthorization criteria

• Member has achieved or maintained a positive clinical response as evidenced by low disease activity or improvement in signs and symptoms of the condition

Approval duration

Initial 12 months, Reauthorization 12 months