Information posted July 24, 2020
The Vendor Drug Program (VDP) routinely updates existing clinical prior authorization criteria to reflect recent U.S. Food and Drug Administration (FDA)-approved indications or safety information from the product package insert, and will revise the Dupixent (dupilumab) clinical prior authorization on August 24, 2020:
- Current criteria allows prescribing for patients who are 12 years of age and older with moderate to severe atopic dermatitis.
- Revised criteria will allow prescribing for patients who are 6 years of age 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 shows the prior authorization that each managed care organization (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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