Rinvoq — CareFirst (Caremark)
Atopic dermatitis
Preferred products
- Adbry
- Dupixent
- Ebglyss
- Nemluvio
- Cibinqo
Initial criteria
- Member age ≥ 12 years with moderate-to-severe atopic dermatitis
- 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 year
- OR member meets all of the following: affected body surface ≥ 10% or crucial body areas affected (e.g., hands, feet, face, neck, scalp, genitals/groin, intertriginous areas); and member has had an inadequate response to treatment with a medium to super-high potency topical corticosteroid, topical calcineurin inhibitor, topical JAK inhibitor, or topical PDE-4 inhibitor, OR use of these topical agents is not advisable; AND member has had an inadequate response or intolerance to a biologic or systemic targeted synthetic drug indicated for atopic dermatitis
Reauthorization criteria
- Member age ≥ 12 years using the medication for moderate-to-severe atopic dermatitis and who achieves or maintains a positive clinical response as evidenced by low disease activity (clear or almost clear skin) or improvement in signs and symptoms such as redness, itching, oozing/crusting
Approval duration
Initial: 4 months; Reauthorization: 12 months