Dupixent — Medical Mutual

Initial criteria

• Patient is age ≥ 12 years; AND
• Patient has urticaria > 6 weeks with symptoms > 3 days/week despite high dose daily non-sedating H1 antihistamine (up to 4x FDA dose); AND
• Prescribed by or in consultation with allergist, immunologist, or dermatologist

Reauthorization criteria

• Patient has received ≥ 6 months Dupixent; AND
• Patient has clinical response (decreased itch, hives number/size)

Approval duration

6 months initial, 1 year reauth