Dupixent (dupilumab) Criteria Update

Date: December 7, 2021 Attention: Primary Care Providers and Pulmonologists Subject: Dupixent (dupilumab) Criteria Update Effective Date: October 20, 2021Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Effective October 20, 2021, Texas Medicaid revised criteria of the Dupixent (dupilumab).  Dupixent is FDA-approved as an add-on maintenance treatment for individuals 6 years and older with moderate-to-severe eosinophilic phenotype asthma, or with oral corticosteroid dependent asthma. How this impacts providers: The previous criteria required individuals to be 12 years and older for diagnosis of moderate to severe asthma. The revised criteria omits that step to expand treatment to individuals 6 years and older. Next steps for providers: Providers need to use updated prior authorization forms and providers should share this update with their staff as well. Resources:

1. Navitus TX Medicaid Prior Authorization Forms

If you have any questions, please email TCHP Pharmacy Department at: TCHPPharmacy@texaschildrens.org. For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.