Dupixent — Medical Mutual

Asthma

Initial criteria

Patient is age ≥ 6 years; AND
Patient has either blood eosinophil count ≥ 150 cells/µL within last 6 weeks OR prior to treatment, OR patient has oral corticosteroid-dependent asthma (≥ 5 mg prednisone daily for ≥ 6 months); AND
Patient has received ≥ 3 consecutive months of combination therapy with inhaled corticosteroid AND one additional asthma controller/maintenance medication; AND
Patient has asthma that is uncontrolled or was uncontrolled at baseline, defined by ≥ 2 exacerbations needing systemic corticosteroids in past year, OR ≥ 1 hospitalization/ED/urgent care visit in past year, OR FEV1 < 80% predicted, OR FEV1/FVC < 0.80, OR worsening with corticosteroid taper; AND
Prescribed by or in consultation with allergist, immunologist, or pulmonologist

Patient has received ≥ 6 months of therapy with Dupixent; AND
Patient continues therapy with one inhaled corticosteroid or corticosteroid-containing combination inhaler; AND
Patient has responded to therapy as determined by the prescriber

6 months initial, 1 year reauth