Dupixent (dupilumab) — United Healthcare

Initial criteria

• Diagnosis of chronic spontaneous urticaria
• One of: (a) Remains symptomatic despite ≥ 2-week trial of, or history of contraindication or intolerance to, two H1-antihistamines [e.g., Allegra (fexofenadine), Benadryl (diphenhydramine), Claritin (loratadine)] OR (b) Remains symptomatic despite ≥ 2-week trial of, or history of contraindication or intolerance to BOTH: i. A second generation H1-antihistamine [e.g., Allegra (fexofenadine), Claritin (loratadine), Zyrtec (cetirizine)] AND ii. One of: a different second generation H1-antihistamine OR a first generation H1-antihistamine OR an H2-antihistamine OR a leukotriene modifier
• Patient is not receiving Dupixent in combination with Xolair (omalizumab) for same indication
• Prescribed by allergist OR dermatologist OR immunologist

Reauthorization criteria

• Documentation of positive clinical response to Dupixent therapy (e.g., reduction in exacerbations, itch severity, hives)
• Patient is not receiving Dupixent in combination with Xolair (omalizumab) for same indication
• Prescribed by allergist OR dermatologist OR immunologist

Approval duration

12 months