Cibinqo (abrocitinib) — United Healthcare

Initial criteria

• Diagnosis of moderate-to-severe chronic atopic dermatitis
• History of failure, contraindication, or intolerance to at least one systemic drug product for the treatment of atopic dermatitis
• Patient is not receiving Cibinqo in combination with any of the following: Biologic immunomodulator [e.g., Adbry (tralokinumab-ldrm), Dupixent (dupilumab), Ebglyss (lebrikizumab-lbkz), Nemluvio (nemolizumab-ilto)] OR Janus kinase inhibitor [e.g., Olumiant (baricitinib), Opzelura (topical ruxolitinib), Rinvoq (upadacitinib), Xeljanz/XR (tofacitinib)] OR Potent immunosuppressant (e.g., azathioprine, cyclosporine, mycophenolate mofetil)

Reauthorization criteria

• Documentation of positive clinical response to Cibinqo therapy
• Patient is not receiving Cibinqo in combination with any of the following: Biologic immunomodulator [e.g., Adbry (tralokinumab-ldrm), Dupixent (dupilumab), Ebglyss (lebrikizumab-lbkz), Nemluvio (nemolizumab-ilto)] OR Janus kinase inhibitor [e.g., Olumiant (baricitinib), Opzelura (topical ruxolitinib), Rinvoq (upadacitinib), Xeljanz/XR (tofacitinib)] OR Potent immunosuppressant (e.g., azathioprine, cyclosporine, mycophenolate mofetil)

Approval duration

12 months