Diagnosis: Atopic Dermatitis.
Treatment: Dupixent Pen 300mg/2ml PEN INJCTR 4.000 For 14 Days.
The insurer denied the Dupixent Pen 300mg/2ml PEN INJCTR 4.000 For 14 Days.
The denial is overturned.

The patient is a female with atopic dermatitis, 14% BSA (body surface area) to the trunk and extremities, treated with topical steroids and topical calcineurin inhibitors as well as methotrexate. The provider is requesting Dupixent. The health plan denied the request as the patient has not tried and failed Eucrisa.

Yes, the requested Dupixent is medically necessary.
This patient has tried and failed the appropriate therapies and has substantial disease. Eucrisa is only indicated for mild atopic dermatitis.

Dupilumab is United States Food and Drug Administration indicated for treatment of recalcitrant atopic dermatitis, approved several years ago. Two trials, SOLO-1 and SOLO-2, demonstrated that patients treated with Dupilumab experienced significant, clinically meaningful improvements in their atopic dermatitis at week 16 as measured by the EASI score (Eczema Area and Severity Index). Dupilumab was well tolerated with the most commonly reported side effects including injection site reactions and conjunctivitis. Dupilumab is a novel interleukin-4 and interleukin-13 blocker, which inhibits the arm of the immune system responsible for atopic dermatitis. In clinical trials, after 12 weeks of monotherapy with dupilumab, 85% of patients had a greater than 50% reduction in eczema severity and pruritus scores decreased by 57.1%. In phase III clinical trials, dupilumab led to a 75% improvement in eczema severity, when compared to placebo, and decreased symptoms of anxiety and depression. It also led to a significantly decreased use of topical corticosteroids. The safety and efficacy were supported in a recent meta-analysis of all published dupilumab paper (Han et al.).

No, the health plan did not act reasonably, with sound medical judgment, and in the best interest of the patient.