Diagnosis: Asthma
Treatment: Pharmacy/Prescription drugs

The patient is a male with a medical history of severe persistent asthma on therapy with inhaled corticosteroid (ICS), long acting beta agonist (LABA), leukotriene modifiers, albuterol and as needed prednisone. He had a blood eosinophil level of 84 cells/mcL. The provider is seeking biologic therapy with Dupixent to treat the patient's severe persistent asthma. This is the subject of this review.

The health plan's determination is upheld. Dupixent 200 mg/1.14 Syringe 2.280 for 14 Days is not medically necessary for this patient.

Dupixent is indicated as an add-on maintenance treatment in patients with moderate-to-severe asthma aged 12 years and older with an eosinophilic phenotype or with oral corticosteroid dependent asthma. Castro et al. demonstrated that patients who received Dupixent had significantly lower rates of severe asthma exacerbation than those who received placebo, as well as better lung function and asthma control. Wenzel et al. demonstrated Dupixent increased lung function and reduced severe exacerbations in patients with uncontrolled persistent asthma. Rabe et al. demonstrated that in patients with glucocorticoid-dependent severe asthma, Dupixent treatment reduced oral glucocorticoid use while decreasing the rate of severe exacerbations and increasing the FEV1.

Per the clinical documentation, this patient has severe persistent asthma therapy with inhaled corticosteroid (ICS), long acting beta agonist (LABA), leukotriene modifiers and albuterol. Also, per the clinic note, the provider states the patient does not have an elevated eosinophil count (84 cells/mcL) and does not have steroid dependent asthma. Therefore, without documentation of maximal asthma therapy with high dose inhaled corticosteroids and long acting beta agonists or steroid dependent asthma in the setting of eosinophilic asthma, Dupixent is not medically necessary.