Diagnosis: Atopic Dermatitis
Treatment: Dupixent SOPN (Solution Pen-Injector) 300MG (milligrams)/2ML (milliliters)
The insurer denied the Dupixent SOPN 300MG/2ML.
The denial is upheld.

The patient is a female with atopic dermatitis, treated with multiple topical steroids. The provider is requesting Dupixent. The health plan requires use of Protopic and Opzelura. The patient has already responded favorably to Dupixent. She presented reporting her rash had been present for months with no prior treatment and is located on the eyelid and hand.

No, the proposed treatment with Dupixent is not medically necessary.

Yes, the health plan did act reasonably, with sound medical judgment, and in the best interest of the patient.

This patient has not demonstrated an adequate trial and failure to all other standard of care measures for atopic dermatitis, including topical calcineurin inhibitors such as Protopic. Given that the rash has only been present for roughly a year and is limited to small areas, patch testing is recommended to rule out contact dermatitis. Therefore, the requested Dupixent is not medically necessary.