Nemluvio — Medical Mutual

Atopic dermatitis

Initial criteria

Patient is age ≥ 12 years; AND
According to the prescriber, the patient has atopic dermatitis involvement estimated to be ≥ 10% of the body surface area; AND
Patient meets two of the following three conditions: (a) Patient did not respond adequately to (or is not a candidate for) a 3-month minimum trial of topical agents [e.g., corticosteroids, calcineurin inhibitors (tacrolimus or pimecrolimus), crisaborole]; OR (b) Patient did not respond adequately to (or is not a candidate for) a 3-month minimum trial of at least one systemic agent (e.g., cyclosporine, azathioprine, methotrexate, mycophenolate mofetil, oral corticosteroids); OR (c) Patient did not respond adequately to (or is not a candidate for) a 3-month minimum trial of phototherapy (e.g., Psoralens with UVA light (PUVA), UVB); AND
Patient meets ONE of the following: (a) For initial therapy, Nemluvio will be used in combination with a topical corticosteroid and/or a topical calcineurin inhibitor; OR (b) Patient’s atopic dermatitis has sufficiently improved with Nemluvio and topical therapy has been discontinued; AND
Nemluvio is prescribed by or in consultation with an allergist, immunologist, or dermatologist.

Patient has already received at least 4 months of therapy with Nemluvio; AND
Patient has responded to therapy as determined by the prescriber (e.g., improvements in erythema, induration/papulation/edema, excoriations, lichenification, reduced pruritus, decreased requirement for other topical or systemic therapies, reduced body surface area affected, or other responses observed).

initial: 4 months; reauth: 1 year