Skip to content
The Policy VaultThe Policy Vault

DupixentMedica

Chronic Rhinosinusitis with Nasal Polyps

Initial criteria

  • age ≥ 12 years
  • diagnosis confirmed by direct examination, endoscopy, or sinus CT scan
  • two or more symptoms (nasal congestion, nasal obstruction, nasal discharge, or reduction/loss of smell) for at least 6 months
  • received at least 4 weeks of intranasal corticosteroid therapy
  • will continue intranasal corticosteroid with Dupixent
  • meets one of the following: received ≥ 1 course of systemic corticosteroid within previous 2 years OR contraindication to systemic corticosteroid therapy OR prior nasal polyp surgery
  • prescribed by or in consultation with allergist, immunologist, or otolaryngologist (ENT)

Reauthorization criteria

  • already received ≥ 6 months of Dupixent therapy
  • continues use of intranasal corticosteroid
  • has responded to therapy as determined by prescriber (e.g., reduced nasal polyp size, improved nasal congestion, reduced sinus opacification, decreased sinonasal symptoms, improved sense of smell)

Approval duration

initial 6 months, renewal 1 year