Ebglyss (lebrikizumab-lbkz subcutaneous injection – Eli Lilly) — Cigna

Initial criteria

• Patient meets ONE of the following criteria (a or b): a) patient age ≥ 18 years; OR b) patient age 12 to 17 years AND weight ≥ 40 kg
• Patient has atopic dermatitis involvement estimated to be ≥ 10% of the body surface area according to the prescriber
• Patient has tried at least one medium-, medium-high-, high-, and/or super-high-potency prescription topical corticosteroid
• This topical corticosteroid was applied daily for at least 28 consecutive days
• Inadequate efficacy was demonstrated with this topical corticosteroid therapy according to the prescriber
• 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 Ebglyss
• Patient has responded to therapy as determined by the prescriber (e.g., improvements in erythema, induration/papulation/edema, excoriations, lichenification; reduced pruritus; decreased need for other therapies; reduced body surface area affected)

Approval duration

initial 4 months; reauth 1 year