upadacitinib — United Healthcare
Atopic Dermatitis
Preferred products
- medium to very-high potency topical corticosteroids
- topical calcineurin inhibitors
- Eucrisa
- systemic atopic dermatitis biologics such as Adbry, Dupixent, Ebglyss, Nemluvio
Initial criteria
- Diagnosis of moderate-to-severe chronic atopic dermatitis
- AND One of the following:
- (a) BOTH of the following:
- • History of failure, contraindication, or intolerance to two of the following topical therapy classes (document drug, date of trial, and/or contraindication): medium to very-high potency topical corticosteroid, topical calcineurin inhibitor, or Eucrisa (crisaborole)
- AND • One of the following:
- a. BOTH of the following: submission of medical records documenting 3 month trial of a systemic drug product for atopic dermatitis (e.g., Adbry, Dupixent, Ebglyss, Nemluvio) AND physician attests patient was not adequately controlled
- OR b. Physician attests systemic treatment with all FDA-approved chronic atopic dermatitis therapies (Adbry, Dupixent, Ebglyss, Nemluvio) is inadvisable with documented contraindication rationale
- OR c. Patient has documented needle-phobia (DSM-V-TR 300.29)
- OR (b) BOTH of the following (continues beyond current chunk)