Nemluvio (nemolizumab-ilto) — United Healthcare

atopic dermatitis

Initial criteria

Diagnosis of moderate to severe atopic dermatitis
Will be used in combination with topical corticosteroids and/or calcineurin inhibitors when the disease is not adequately controlled with topical prescription therapies
Patient is not receiving Nemluvio in combination with either of the following for treatment of the same indication: Biologic immunomodulator [e.g., Adbry (tralokinumab-ldrm), Dupixent (dupilumab), Ebglyss (lebrikizumab-lbkz)] OR Janus kinase inhibitor [e.g., Rinvoq (upadacitinib), Xeljanz/XR (tofacitinib), Opzelura (topical ruxolitinib), Cibinqo (abrocitinib)]

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

12 months