Ebglyss (lebrikizumab-lbkz) — CareFirst (Caremark)

Moderate-to-severe atopic dermatitis

Preferred products

Member is age ≥ 12 years and weighs ≥ 40 kg
Medication is prescribed by or in consultation with a dermatologist or allergist/immunologist
Member is not using Ebglyss concomitantly with another biologic drug or targeted synthetic drug for the same indication
Authorization of 4 months may be granted for members who have previously received a biologic (e.g., Adbry, Dupixent, Nemluvio) or systemic targeted synthetic drug (e.g., Cibinqo, Rinvoq) indicated for moderate-to-severe atopic dermatitis in the past year
Authorization of 4 months may be granted when ALL of the following are met:
• Affected body surface area ≥ 10% OR crucial body areas (hands, feet, face, neck, scalp, genitals/groin, intertriginous areas) are affected
• Member has had an inadequate treatment response in the past year to ONE of the following: medium potency to super-high potency topical corticosteroid, topical calcineurin inhibitor, topical Janus kinase (JAK) inhibitor, or topical phosphodiesterase-4 (PDE-4) inhibitor OR the use of these therapies are not advisable (e.g., due to contraindications or prior intolerances)

Member is age ≥ 12 years and weighs ≥ 40 kg
Member is using the requested medication for moderate-to-severe atopic dermatitis
Member has achieved or maintained a positive clinical response as evidenced by low disease activity (clear or almost clear skin) or improvement in signs and symptoms of atopic dermatitis (e.g., redness, itching, oozing/crusting)

Initial: 4 months; Reauthorization: 12 months