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Dupixent — Cigna

Atopic Dermatitis

Initial criteria

  • Patient is age ≥ 6 months; AND
  • Patient meets ONE of the following: a) Atopic dermatitis involvement ≥ 10% BSA; OR b) Patient has moderate to severe hand and/or foot atopic dermatitis AND is age ≥ 12 years; AND
  • Patient has tried at least one medium-, medium-high-, high-, or super-high-potency prescription topical corticosteroid applied daily for ≥ 28 consecutive days with inadequate efficacy; AND
  • Medication is prescribed by or in consultation with an allergist, immunologist, or dermatologist.

Reauthorization criteria

  • Patient has already received at least 4 months of therapy with Dupixent; AND
  • Patient has responded to therapy as determined by the prescriber (e.g., improvements in erythema, papulation, pruritus, BSA affected, or reduced need for other therapies).

Approval duration

initial 4 months; reauth 1 year