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DUPIXENT (raised EOS count required for all)
1. Atopic derm (L20.9 or L20.89) -6 months or older with diagnosis of moderate-to-severe atopic dermatitis -documentation of disease burden (SCORAD, BSA %, EASI, POEM, etc) -inadequate response to potent topical corticosteroids and topical calcineurin inhibitors -inadequate response to oral systemic immunosuppressants or corticosteroids
2. 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
3. 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
4. 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
PA: Dupixent required through pharmacy benefits insurance; not available to buy & bill through medical benefits