Dupixent (dupilumab) — Highmark

Initial criteria

• age ≥ 12 years
• diagnosis of chronic rhinosinusitis with nasal polyposis
• prescriber submits documentation of baseline bilateral nasal polyp score
• prescriber submits documentation of baseline nasal congestion score
• therapeutic failure, contraindication, or intolerance to intra-nasal corticosteroid AND 14 day course of oral corticosteroids

Reauthorization criteria

• prescriber attests decrease in nasal polyp score OR reduction in nasal congestion/obstruction severity score

Approval duration

initial up to 6 months; reauthorization up to 12 months