CurrentAvMedPolicy N/A

Nemluvio

Pharmacy prior authorization and step-edit criteria for Nemluvio (nemolizumab-ilto) covering indications, required baseline documentation, required prior trials/therapies, dosing, quantity limits, prescriber qualifications, and reauthorization requirements for Prurigo Nodularis and Atopic Dermatitis.

Policy Summary

PayerAvMed

PolicyNemluvio

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionPrescribing physician must sign the PA request and submit chart notes, recent weight, PP-NRS, lesion counts, prior therapy documentation and pharmacy paid claims; fax to 1-305-671-0200.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes.

2Indications covered (Prurigo Nodularis; Atopic Dermatitis)

1/28dQuantity limit

>=7PP-NRS approval threshold

>=20Lesion count requirement for PN

Coverage Summary

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Scope: Pharmacy prior authorization and step-edit policy for Nemluvio (nemolizumab‑ilto) covering Prurigo Nodularis and Moderate‑to‑Severe Atopic Dermatitis. Required prescriber specialty is an allergist, dermatologist, or immunologist. Recommended dosing by weight: for patients <90 kg, a 60 mg subcutaneous dose followed by 30 mg every 4 weeks; for patients ≥90 kg, 60 mg followed by 60 mg every 4 weeks. Initial authorization durations: 6 months for Prurigo Nodularis and 4 months for Atopic Dermatitis. Reauthorization options include 12 months for Prurigo Nodularis and maintenance dosing adjustments (e.g., reduction to 30 mg every 8 weeks after response) for Atopic Dermatitis. Quantity limit is 1 pen per 28 days.