Dupixent — Cigna

Chronic Obstructive Pulmonary Disease (COPD)

Initial criteria

Patient is age ≥ 18 years; AND
Patient meets ONE of the following (a or b):
a) Blood eosinophil level ≥ 300 cells/µL within previous 6 weeks; OR
b) Blood eosinophil level ≥ 300 cells/µL prior to treatment with Dupixent or another monoclonal antibody therapy that may alter blood eosinophil levels; AND
Patient meets ONE of the following (a or b):
a) At least 3 consecutive months of combination therapy with inhaled LABA, LAMA, and ICS; OR
b) At least 3 consecutive months of combination therapy with inhaled LABA and LAMA AND contraindication to inhaled corticosteroid; AND
Patient meets ONE of the following (a or b):
a) Two or more COPD exacerbations requiring systemic corticosteroid with or without antibiotic in previous 12 months; OR
b) One or more COPD exacerbations requiring hospitalization in previous 12 months; AND
Medication is prescribed by or in consultation with an allergist, immunologist, or pulmonologist.

Patient has already received at least 6 months of therapy with Dupixent; AND
Patient continues to receive combination therapy with inhaled LABA and LAMA; AND
Patient has experienced a beneficial clinical response, defined by ONE of the following (a, b, c, d, or e):
a) Reduced COPD symptoms; OR
b) Reduced COPD exacerbations; OR
c) Reduced COPD-related hospitalizations; OR
d) Reduced emergency department or urgent care visits; OR
e) Improved lung function parameters.

initial 6 months; reauth 1 year