Nemluvio (nemolizumab-ilto) — CareFirst (Caremark)

Initial criteria

• Member age ≥ 12 years
• Authorization of 4 months may be granted for members 12 years of age or older who have previously received a biologic (e.g., Adbry, Dupixent, Ebglyss) or systemic targeted synthetic drug (e.g., Cibinqo, Rinvoq) indicated for moderate-to-severe atopic dermatitis in the past year
• The requested medication must be prescribed in combination with a low potency to medium potency topical corticosteroid (see Appendix A) or topical calcineurin inhibitor, unless the use of these topical therapies is not advisable (e.g., due to contraindications or prior intolerances)
• For other members, authorization of 4 months may be granted when all 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 response within the past year to at least one of the following: medium potency to super-high potency topical corticosteroid, topical calcineurin inhibitor, topical JAK inhibitor, or topical PDE-4 inhibitor; OR use of these therapies is not advisable (e.g., due to contraindications or prior intolerance)
• Requested medication is prescribed in combination with a low to medium potency topical corticosteroid or topical calcineurin inhibitor unless these are not advisable (e.g., due to contraindication or prior intolerance)
• Medication must be prescribed by or in consultation with a dermatologist or allergist/immunologist
• Member cannot use the requested medication concomitantly with any other biologic or targeted synthetic drug for the same indication

Reauthorization criteria

• Authorization of 12 months may be granted for members 12 years of age or older (including new members) using the requested medication when the 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)

Approval duration

Initial: 4 months; Renewal: 12 months