Cibinqo (abrocitinib) — Point32Health

Initial criteria

• Documented diagnosis of moderate to severe atopic dermatitis
• Documentation the patient’s condition meets ONE of the following: Body Surface Area (BSA) ≥ 10% OR Eczema Area and Severity Index (EASI) score ≥ 16 OR 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 of the following: (a) Inadequate response or adverse reaction to ONE of the following: medium or high potency topical corticosteroid, calcineurin inhibitor, or crisaborole OR (b) Contraindication to ALL of the following: medium and high potency topical corticosteroids, topical calcineurin inhibitors, and crisaborole
• Documentation of ONE of the following: (a) Inadequate response or adverse reaction following a minimum 12-week supply of ONE systemic drug product for the treatment of atopic dermatitis (e.g., Adbry, Dupixent) OR (b) Contraindication to ALL systemic drug products for the treatment of atopic dermatitis

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 of the following: (a) Reduction in body surface area involvement relative to pretreatment baseline OR (b) Improvement in atopic dermatitis symptoms as evidenced by marked improvements in 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