Dupixent — Cigna
Chronic Spontaneous Urticaria (Chronic Idiopathic Urticaria)
Initial criteria
- Patient is age ≥ 12 years; AND
- Has/had urticaria >6 weeks with symptoms >3 days/week despite daily non-sedating H1 antihistamine at up to 4× FDA-approved dose; AND
- Medication is prescribed by or in consultation with an allergist, immunologist, or dermatologist.
Reauthorization criteria
- Patient has already received at least 6 months of therapy with Dupixent; AND
- Patient has experienced beneficial clinical response, defined by ONE of the following (a, b, or c):
- a) Decreased itch severity; OR
- b) Decreased number of hives; OR
- c) Decreased size of hives.
Approval duration
initial 6 months; reauth 1 year