Ebglyss (lebrikizumab-lbkz) — Point32Health
Atopic dermatitis
Preferred products
- Adbry
- Dupixent
- Cibinqo
- Rinvoq
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. Trial and failure of at least two of the listed medications from each of the following therapeutic categories (only one medication required if only one is available for a listed category): Interleukin Antagonists: Adbry, Dupixent; Janus Kinase Inhibitor: Cibinqo, Rinvoq OR b. Contraindication to all the following medications: Adbry, Cibinqo, Dupixent, Rinvoq
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 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 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