Differences

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--- dupixent_start [2025/05/22 13:50] – 73.123.100.169
+++ dupixent_start [2025/11/10 17:04] (current) – 73.123.100.169
@@ Line 5: / Line 5: @@
 . Nasal Polyps (J33.9 or J33.0) -18 years or older with diagnosis of polyps supported by rhinoscopy, endoscopy or CT scan -inadequate response to intranasal and systemic corticosteroids -history of sino-nasal surgery *Depending on insurance, some PA's will ask if med is being prescribed with referral from/ in consultation with ENT provider* -BCBS Federal will only approve Dupixent for Nasal Polyps if ENT prescribing
-. Asthma (J45.40 or J45.50) -6 years or older with diagnosis of moderate-to-severe eosinophilic (EOs > 150 cells/uL) or oral corticosteroid dependent asthma -documentation of 3 months of patient trying asthma treatments -documentation of frequency of hospitalizations, exacerbations, use of rescue therapy
+. Asthma (J45.40 or J45.50) -6 years or older with diagnosis of moderate-to-severe asthma of the following phenotypes:
+-eosinophilic (EOs > 150 cells/uL within the past 6 months, or >300 cells/uL within the past year)
+-oral corticosteroid dependent asthma requiring documentation of 3 months of patient trying asthma medications including a) high dose ICS, b) additional controller therapy (LABA or leukotriene modifier) and c) oral corticosteroids for at least 6 months (greater than or equal to 5mg per day of prednisone)
 . EoE (K20.0) -1 year or older & weighs over 15kg -diagnosis of EoE as supported by esophageal biopsy with >15 EOS/HPF -documentation of inadequate response to at least 8 weeks of high dose PPI and 6-8 weeks of oral swallowed steroids like budesonide or fluticasone propionate
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 . Prurigo Nodularis (L28.1) -18 years or older & has failed trials of other therapies (antihistamines, xolair, etc)
-. Chronic spontaneous urticaria (L50.1, L50.8, L50.9) -12 years or older (and over 66lb) with diagnosis of CSU, documentation of inadequate response to H1 antihistamines.
+. Chronic spontaneous urticaria (L50.1, L50.8, L50.9) -12 years or older (and over 66lb) with diagnosis of CSU, documentation of inadequate response to H1 antihistamines *Not all insurance plans have released their criteria for approval for Dupixent to treat CSU*
 . COPD (J44) -18 years or older as add-on maintenance treatment for adults with inadequately controlled chronic obstructive pulmonary disease and a high number of blood eosinophils
-PA: Dupixent required through pharmacy benefits insurance; not available to buy & bill through medical benefits (can be costly for Medicare patients because of this)
+PA: required through pharmacy benefits insurance; not available to buy & bill through medical benefits at this time (can be costly for Medicare patients because of this)
+BCBS FEP insurance will no longer cover Dupixent as of 1/2026.
+link for DWM enrollment forms/ reapplying for PAP: www.dupixentmywayportal.com
+(code is 8443879370 aka DMW fax#)
+link to check on copay assistance cards: www.patientrebateonline.com
+direct contact for patient assistance:
+Char Williams, Territory Case Manager, Sonexus™ Access and Patient Support
+S. Edmonds Lane, Suite 300 | Lewisville, TX  75067
+.844.387.4936 ext. 60656
+Pharmacy for patients to fill med through PAP (no longer Theracom as of 10/1/25):
+Sonexus Health Pharmacy Services
+S. Edmonds Ln, Ste 400 Lewisville, TX 75067
+P: 866-834-0739
+F: 469-240-8518
+NPI: 1447680210