Diagnosis: Severe Atopic Eczema

Treatment: Dupixent 200mg (milligrams)/1.14 ml (milliliter)

The insurer denied coverage for Dupixent 200mg/1.14 ml.

The denial is overturned.

The patient is a male with a history of atopic dermatitis (AD). The patient, according to the documentation note, is being treated with oral cyclosporine, prednisone, and hydroxyzine as well as topical steroids. The requested medication is Dupixent.

Dupixent is medically necessary for the treatment of the patient's diagnosis. The patient has decreased systemic treatment options available which could safely be administered given his age. The patient has failed oral therapy with cyclosporine and prednisone as well as topical therapy with steroids. In a randomized trial in adolescents and older, Simpson, et al found that "In this study, dupilumab significantly improved AD signs, symptoms, and quality of life in adolescents with moderate to severe AD, with an acceptable safety profile. Placebo-corrected efficacy and safety of dupilumab were similar in adolescents and adults."

Dupixent is approved for use in the treatment of the patient's atopic dermatitis under close medical supervision and at an appropriate dosing schedule at the discretion of the treating physician.

The insurer's denial of coverage for Formulary Exception for Dupixent 200mg/1.14 ml is reversed.