Cibinqo (abrocitinib tablets – Pfizer) — Cigna

Atopic Dermatitis

Initial criteria

Patient is age ≥ 12 years
Patient meets ONE of the following (a or b): a) Patient has had a 4-month trial of at least ONE systemic therapy; OR b) Patient has tried at least ONE systemic therapy but was unable to tolerate a 4-month trial
Examples of systemic therapies include Dupixent (dupilumab subcutaneous injection), Ebglyss (lebrikizumab-lbkz subcutaneous injection), Nemluvio (nemolizumab-ilto subcutaneous injection), Adbry (tralokinumab-ldrm subcutaneous injection), methotrexate, azathioprine, cyclosporine, and mycophenolate mofetil
Medication is prescribed by or in consultation with an allergist, immunologist, or dermatologist

Patient has already received at least 90 days of therapy with Cibinqo
Patient experienced a beneficial clinical response, defined as improvement from baseline (prior to initiating Cibinqo) in at least one of the following: estimated body surface area affected, erythema, induration/papulation/edema, excoriations, lichenification, and/or decreased requirement for other topical or systemic therapies for atopic dermatitis
Compared with baseline (prior to receiving Cibinqo), patient experienced an improvement in at least one symptom, such as decreased itching

initial 3 months; continuation 1 year