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Rinvoq (upadacitinib) — CareFirst (Caremark)

moderate-to-severe atopic dermatitis

Preferred products

  • Adbry
  • Dupixent
  • Ebglyss
  • Nemluvio
  • Cibinqo

Initial criteria

  • Member age ≥ 12 years
  • Prescribed by or in consultation with a dermatologist or allergist/immunologist
  • Member has had an inadequate response or intolerance to at least one biologic (e.g., Adbry, Dupixent, Ebglyss, Nemluvio) OR a systemic targeted synthetic drug (e.g., Cibinqo) in the past 180 days OR documentation shows topical therapies are inadequate or not advisable
  • For moderate-to-severe atopic dermatitis: 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 to one of the following in the past 180 days: high potency or super-high potency topical corticosteroid, topical calcineurin inhibitor, topical JAK inhibitor, or topical PDE-4 inhibitor OR the use of those therapies is not advisable (due to contraindication, prior intolerance, or inappropriate potency for age)
  • Member has had an inadequate response or intolerance to treatment with a biologic (e.g., Adbry, Dupixent, Eblgyss, Nemluvio) or a systemic targeted synthetic drug (e.g., Cibinqo) indicated for atopic dermatitis
  • Member has a documented negative tuberculosis (TB) test (TST or IGRA) within 12 months prior to initiation for those naïve to biologic or targeted synthetic drugs associated with increased TB risk
  • If TB screening is positive, further testing must confirm no active disease; if latent TB is present, treatment must start before initiating Rinvoq
  • Rinvoq will not be used concomitantly with other biologic drugs, targeted synthetic drugs, or potent immunosuppressants (e.g., azathioprine, cyclosporine)
  • Use is consistent with FDA-approved labeling and/or evidence-based guidelines

Reauthorization criteria

  • Member age ≥ 12 years
  • Currently using Rinvoq for moderate-to-severe atopic dermatitis
  • Documentation of positive clinical response, demonstrated by low disease activity (clear or almost clear skin) or improvement in signs and symptoms (e.g., redness, itching, oozing/crusting)

Approval duration

Initial: 4 months; Reauthorization: 12 months