Nemluvio (nemolizumab-ilto subcutaneous injection – Galderma) — Cigna

Prurigo nodularis

Initial criteria

Patient is age ≥ 18 years; AND
Patient has ≥ 20 identifiable nodular lesions in total on both arms, and/or both legs, and/or trunk; AND
Patient has experienced pruritus for ≥ 6 weeks; AND
Patient meets ONE of the following (a or b): a) The prurigo nodularis is NOT medication-induced or secondary to a non-dermatologic condition such as neuropathy or a psychiatric disease; OR b) The patient has a secondary cause of prurigo nodularis that has been identified and adequately managed, according to the prescriber; AND
Patient meets ALL of the following (a, b, and c): a) Patient has tried at least one high- or super-high-potency prescription topical corticosteroid; AND b) This topical corticosteroid was applied daily for at least 14 consecutive days; AND c) Inadequate efficacy was demonstrated with this topical corticosteroid therapy, according to the prescriber; AND
The medication is prescribed by or in consultation with an allergist, immunologist, or dermatologist.

Patient has already received at least 4 months of therapy with Nemluvio; 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 4 months, reauth 1 year