Adbry (tralokinumab-ldrm) — United Healthcare

Initial criteria

• Diagnosis of moderate to severe chronic atopic dermatitis
• History of failure, contraindication, or intolerance to topical therapies
• Patient is not receiving Adbry in combination with either of the following:
• Biologic immunomodulator [e.g., Dupixent (dupilumab), Ebglyss (lebrikizumab-lbkz), Nemluvio (nemolizumab-ilto)]
• Janus kinase inhibitor [e.g., Cibinqo (abrocitinib), Opzelura (topical ruxolitinib), Rinvoq (upadacitinib), Xeljanz/XR (tofacitinib)]

Reauthorization criteria

• Documentation of positive clinical response to Adbry therapy
• Patient is not receiving Adbry in combination with either of the following:
• Biologic immunomodulator [e.g., Dupixent (dupilumab), Ebglyss (lebrikizumab-lbkz), Nemluvio (nemolizumab-ilto)]
• Janus kinase inhibitor [e.g., Cibinqo (abrocitinib), Opzelura (topical ruxolitinib), Rinvoq (upadacitinib), Xeljanz/XR (tofacitinib)]

Approval duration

12 months