Adbry (tralokinumab-ldrm) — Point32Health

Initial criteria

• Documented diagnosis of moderate to severe atopic dermatitis
• Documentation the patient’s condition meets one (1) of the following: a) Body Surface Area (BSA) ≥ 10% OR b) Eczema Area and Severity Index (EASI) score ≥ 16 OR c) Investigator’s Global Assessment/Physician Global Assessment (IGA/PGA) score ≥ 3
• Patient age ≥ 12 years
• Prescribed by or in consultation with a dermatologist, allergist, or immunologist
• Documentation of one (1) of the following: a) Inadequate response or adverse reaction to one (1) of the following: a medium or high potency topical corticosteroid, a calcineurin inhibitor, or crisaborole OR b) Contraindication to all of the following: medium and high potency topical corticosteroids, topical calcineurin inhibitors, and crisaborole

Reauthorization criteria

• Documented diagnosis of moderate to severe atopic dermatitis
• Patient age ≥ 12 years
• Prescribed by or in consultation with a dermatologist, allergist, or immunologist
• Documentation the patient has experienced a therapeutic response as defined by one (1) of the following: a) Reduction in body surface area involvement relative to pretreatment baseline OR b) Improvement in atopic dermatitis symptoms (e.g., pruritus, xerosis, crusting, or lichenification) OR c) Reduction in the use of other topical or systemic therapies

Approval duration

initial 6 months; reauth 12 months