Diagnosis: Skin Disorders-Dermatitis.
Treatment: Pharmacy/Prescription Drugs-Dupixent Injector pen.
The plan denied Dupixent 300 milligrams (mg) /2 milliliters(ml) injector pen as not medically necessary.
The reviewer has upheld in whole the health plan's determination.

The patient has atopic dermatitis (AD), for which the patient has had more than 10% body surface area coverage at several times. The patient has tried and failed topical Triamcinolone. A letter from the treating provider reports treatment failure of topical triamcinolone, Kenalog injection, oral methotrexate, and oral hydroxyzine. A clinic note notes that the patient took methotrexate about 3-4 years ago for 6 months, but it did nothing for him.
There is insufficient documentation of recent combined use of more potent topical steroids and a topical immunomodulator (tacrolimus or pimecrolimus, or Eucrisa (crisaborole))The use of methotrexate is both too far in the past and poorly-documented to conclude any confirmed trial and failure of this systemic therapy.
"Atopic dermatitis (AD) is a common chronic inflammatory skin disease that predominantly affects children. However, it can persist in adulthood and/or start at older ages. Due to its chronic nature and frequently occurring relapses, AD has a substantial effect on patients' quality of life, often requiring long-term systemic treatment, especially in adult patients, who are more frequently refractory to adequate topical treatment with mid- to high-potent corticosteroids and/or calcineurin inhibitors. Therefore, treatment with systemic therapies is often needed to take control of the disease, prevent exacerbations and improve quality of life. However, data regarding systemic treatment effectiveness and long-term safety in adult patients with AD are insufficient. Indeed, standardized international guidelines are lacking, and the treatment approach widely differs among diverse countries. "[2]
The patient has insufficient documented treatment failure with, or true medical contraindication to, either topical calcineurin inhibitors(CNI), and/or standard, first-line oral medications such as Methotrexate, Azathioprine, or Mycophenolate Mofetil that would obviate the need for further topical treatment. Dupixent is not proven to be superior to all other alternatives as per comparative, controlled studies. Therefore, consistent with current medical literature reviews, the requested Dupixent is not medically necessary.