October 30, 2019

On December 18, VDP will include the new FDA indication for Dupixent (dupilumab) in the clinical prior authorization criteria for people in fee-for-service Medicaid.

The FDA approved Dupixent (dupilumab) as an add-on maintenance treatment in adults with inadequately controlled chronic rhinosinusitis with nasal polyposis in June. The prior authorization criteria will be approved for treatment of adults with nasal polyps accompanied by chronic rhinosinusitis whose polyps are not adequately controlled with intranasal steroids. The dosage and frequency for this indication is 300 mg subcutaneously every other week. The Dupixent clinical prior authorization criteria guide (PDF) is available to review these changes.

This prior authorization remains optional for Medicaid managed care. The Pharmacy Clinical Prior Authorization Assistance Chart (PDF) shows the prior authorization each MCO uses and how those authorizations relate to the authorizations used for traditional Medicaid claim processing. This chart is updated quarterly. Providers can also refer to the MCO Resources for links to each MCO's list of clinical prior authorizations.