Nemluvio (nemolizumab-ilto) — CareFirst (Caremark)

Initial criteria

• Member age ≥ 18 years
• Authorization of 6 months may be granted for members who have previously received a biologic drug (e.g., Dupixent) indicated for prurigo nodularis in the past year
• Or authorization of 6 months may be granted when all of the following are met:
• Member has pruritus lasting at least 6 weeks
• Member has history or signs of repeated itch-scratch cycle (e.g., scratching, picking, rubbing)
• Member has a minimum of 20 nodular lesions
• Member has had an inadequate response to at least one of the following: medium to super-high potency topical corticosteroid (see Appendix A), topical calcineurin inhibitor, phototherapy (e.g., UVB, PUVA), or pharmacologic treatment with methotrexate or cyclosporine; OR member has had an intolerance or clinical reason to avoid both medium to super-high potency topical corticosteroid and topical calcineurin inhibitor; OR intolerance or clinical reason to avoid both methotrexate and cyclosporine (Appendix B)
• 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 18 years of age or older (including new members) who are using the requested medication for prurigo nodularis when the member has achieved or maintained a positive clinical response as evidenced by low disease activity (clear or almost clear skin) or reduction in pruritis intensity and improvement in extent and severity of nodular lesions

Approval duration

Initial: 6 months; Renewal: 12 months