Dupixent — Cigna

Prurigo Nodularis

Initial criteria

Patient is age ≥ 18 years; AND
Has ≥ 20 identifiable nodular lesions on arms, legs, and/or trunk; AND
Pruritus duration ≥ 6 weeks; AND
Either prurigo nodularis is not medication-induced/secondary OR secondary cause has been identified and managed; AND
Patient has tried at least one high- or super-high-potency topical corticosteroid applied daily for ≥14 consecutive days with inadequate efficacy; AND
Medication is prescribed by or in consultation with an allergist, immunologist, or dermatologist.

Patient has already received at least 6 months of therapy with Dupixent; AND
Patient has experienced a beneficial clinical response, defined by ONE of the following (a, b, or c):
a) Reduced nodular lesion count; OR
b) Decreased pruritus; OR
c) Reduced nodular lesion size.

initial 6 months; reauth 1 year