Nemluvio (nemolizumab-ilto) — Highmark
Atopic dermatitis (AD)
Initial criteria
- age ≥ 12 years
- diagnosis of moderate-to-severe atopic dermatitis (ICD-10: L20)
- prescribed by or in consultation with an allergist, immunologist, or dermatologist
- ONE of the following: (a) experienced therapeutic failure or intolerance to ONE of the following: (i) one generic topical corticosteroid OR (ii) one generic topical calcineurin inhibitor (tacrolimus or pimecrolimus); OR (b) topical therapy not advisable for maintenance therapy as evidenced by: (i) incapable of applying topical therapies due to extent of body surface area involvement OR (ii) topical therapies contraindicated due to severely damaged skin
Reauthorization criteria
- prescriber attests that member has experienced positive clinical response to therapy
- prescriber has assessed member for dose de-escalation AND EITHER (a) Nemluvio requested at dosing interval of one 30 mg pen every 8 weeks OR (b) prescriber attests member has not achieved clear or almost clear skin and dose de-escalation to every-8-weeks dosing not appropriate
Approval duration
initial 6 months; reauthorization 12 months