Skin Disorder.
Pharmacy/Prescription Drugs.

Diagnosis: Atopic Dermatitis.
Treatment: Dupixent.

The insurer denied Dupixent.
The health plan's determination is upheld.

The patient is a female with moderate to severe atopic dermatitis affecting the groin area, bilateral upper arms, and trunk. The patient has tried and failed topical mometasone, fluocinonide, hydrocortisone, clobetasol, triamcinolone, clotrimazole, Eucrisa, and Protopic, as well as phototherapy.

Health plan coverage of Dupixent is under review for medical necessity.

Dupixent is not medically necessary. The patient has no documented treatment failure with, or true medical contraindication to, either of the standard, first-line oral medications such as Methotrexate, Azathioprine, or Cyclosporine that are used for moderate to severe atopic dermatitis. Dupixent is not proven to be superior to all other formulary alternatives as per comparative, controlled studies. Therefore, consistent with modern dermatology literature, the requested Dupixent is not medically necessary.