Diagnosis: Severe Atopic dermatitis

Treatment: Dupixent 300 milligram (mg)/2 milliliter (ml) subcutaneous (SC) soluble syringe (SOSY)

The insurer denied coverage for Dupixent 300 milligram (mg)/2 milliliter (ml) subcutaneous (SC) soluble syringe (SOSY)

The denial is overturned

The patient has a history of severe atopic dermatitis with numerous superinfections necessitating emergency department (ED) visits. The patient has failed therapy with topical steroids and tacrolimus. The requested medication is Dupixent.

Dupixent is medically necessary for the treatment of the patient's diagnosis, atopic dermatitis. The patient has decreased systemic treatment options available which could safely be administered given her age and severity of atopic dermatitis which has resulted in multiple superinfections. The patient has failed topical therapy with steroids as well as non-steroidal anti-inflammatories tacrolimus. The severity of her disease requires systemic therapy. 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 decision is overturned in whole.

The health plan did not act reasonably with sound medical judgment in the best interest of the patient.

The insurer's denial of coverage for Dupixent 300 milligram (mg)/2 milliliter (ml) SC SOSY
is overturned. Medical necessity is substantiated.