Adbry — Medical Mutual

Atopic Dermatitis

Initial criteria

Patient age ≥ 12 years; AND
Patient has moderate-to-severe atopic dermatitis with at least one of the following: involvement of at least 10% of body surface area (BSA) OR Eczema Area and Severity Index (EASI) score ≥ 16 OR Investigator’s Global Assessment (IGA) score ≥ 3 OR Scoring Atopic Dermatitis (SCORAD) score ≥ 25 OR incapacitation due to AD lesion location; AND
Medication is prescribed by or in consultation with an allergist, immunologist, or dermatologist; AND
Two of the following three (2 of 3) conditions must be met: did not respond adequately (or not a candidate) to a ≥ 3 month trial of topical agents (e.g., corticosteroids, calcineurin inhibitors, crisaborole) OR did not respond adequately (or not a candidate) to a ≥ 3 month trial of at least one systemic agent (e.g., cyclosporine, azathioprine, methotrexate, mycophenolate mofetil, oral corticosteroid) OR did not respond adequately (or not a candidate) to a ≥ 3 month trial of phototherapy (e.g., PUVA, UVB)

Patient has already received ≥ 180 days of therapy with Adbry; AND
Patient experienced a beneficial clinical response, defined as improvement from baseline in at least one of the following: estimated body surface area affected, erythema, induration/papulation/edema, excoriations, lichenification, and/or a decreased requirement for other topical or systemic therapies for atopic dermatitis; AND
Compared with baseline, patient experienced an improvement in at least one symptom, such as decreased itching

initial 6 months; reauth 1 year