July 6, 2020
VDP routinely updates existing clinical prior authorization criteria to reflect recent FDA-approved indications or safety information from the product package insert, and will revise the Dupixent (dupilumab) clinical prior authorization on Aug. 24, 2020:
- Current criteria allow prescribing for patients age 12 and older with moderate to severe atopic dermatitis
- Revised criteria will allow prescribing for age 6 and older
Refer to page 3 of the criteria guide for more information.
This prior authorization is optional for Medicaid managed care. The Pharmacy Clinical Prior Authorization Assistance Chart (PDF) shows the prior authorization that each MCO uses and how they relate to the authorizations used for traditional Medicaid claims processing. This chart is updated quarterly and will be revised again in November. Providers can also refer to the VDP MCO Resources for links to each MCO's clinical prior authorizations.
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