Dupixent (dupilumab) — United Healthcare

Prurigo Nodularis

Initial criteria

Diagnosis of prurigo nodularis
Patient has ≥ 20 nodular lesions
History of failure, contraindication, or intolerance to previous prurigo nodularis treatment(s) (e.g., topical corticosteroids, topical calcineurin inhibitors, topical capsaicin)
Patient is not receiving Dupixent in combination with either of the following for the same indication: (a) Biologic immunomodulator [e.g., Adbry (tralokinumab-ldrm), Nemluvio (nemolizumab-ilto)] (b) Janus kinase inhibitor [e.g., Rinvoq (upadacitinib), Xeljanz/XR (tofacitinib), Opzelura (topical ruxolitinib), Cibinqo (abrocitinib)]
Prescribed by dermatologist OR allergist OR immunologist

Documentation of positive clinical response to Dupixent therapy
Patient is not receiving Dupixent in combination with either biologic immunomodulator [e.g., Adbry (tralokinumab-ldrm), Nemluvio (nemolizumab-ilto)] or Janus kinase inhibitor [e.g., Rinvoq (upadacitinib), Xeljanz/XR (tofacitinib), Opzelura (topical ruxolitinib), Cibinqo (abrocitinib)] for the same indication
Prescribed by dermatologist OR allergist OR immunologist

12 months