Nemluvio (nemolizumab-ilto) — Highmark

Initial criteria

• age ≥ 18 years
• diagnosis of prurigo nodularis (ICD-10: L28.1)
• prescribed by or in consultation with an allergist, immunologist, or dermatologist
• ≥ 10 identifiable nodular lesions
• ONE of the following: (a) experienced therapeutic failure, contraindication, or intolerance to one generic topical corticosteroid 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
• dosing consistent with: < 90 kg: 60 mg initial dose then 30 mg every 4 weeks; ≥ 90 kg: 60 mg initial dose then 60 mg every 4 weeks

Reauthorization criteria

• EITHER prescriber attests member has experienced reduction in itch from baseline OR member has experienced reduction in number of nodules or lesions from baseline

Approval duration

initial 6 months; reauthorization 12 months