Dupixent (dupilumab) — United Healthcare

moderate-to-severe chronic atopic dermatitis

Initial criteria

Diagnosis of moderate-to-severe chronic atopic dermatitis
History of failure, contraindication, or intolerance to two of the following topical therapy classes (document drug, date of trial, and/or contraindication): (a) Medium, high, or very-high potency topical corticosteroid [e.g., Elocon (mometasone furoate), Synalar (fluocinolone acetonide), Lidex (fluocinonide)], (b) Topical calcineurin inhibitor [e.g., Elidel (pimecrolimus), Protopic (tacrolimus)], (c) Eucrisa (crisaborole)
Patient is not receiving Dupixent in combination with a biologic immunomodulator [e.g., Adbry (tralokinumab-ldrm)] or Janus kinase inhibitor [e.g., Rinvoq (upadacitinib), Xeljanz/XR (tofacitinib), Opzelura (topical ruxolitinib), Cibinqo (abrocitinib)]
Prescribed by a Dermatologist, Allergist, or Immunologist

Documentation of positive clinical response to Dupixent therapy
Patient is not receiving Dupixent in combination with a biologic immunomodulator [e.g., Adbry (tralokinumab-ldrm)] or Janus kinase inhibitor [e.g., Rinvoq (upadacitinib), Xeljanz/XR (tofacitinib), Opzelura (topical ruxolitinib), Cibinqo (abrocitinib)]
Prescribed by a Dermatologist, Allergist, or Immunologist

12 months