Dupixent (dupilumab) — Highmark

Initial criteria

• age ≥ 18 years
• diagnosis of prurigo nodularis by specialist (dermatologist, allergist, or immunologist)
• ≥10 identifiable nodular lesions
• therapeutic failure, contraindication, or intolerance to one generic topical corticosteroid OR documentation that topical therapy not advisable for maintenance due to extent of BSA involvement or severely damaged skin

Reauthorization criteria

• prescriber attests reduction in itch from baseline OR reduction in number of nodules or lesions from baseline

Approval duration

initial up to 6 months; reauthorization up to 12 months