CurrentCignaPolicy N/A

Dupixent (dupilumab) — Drug Quantity Management Policy (Per Days)

Defines Cigna's drug quantity limits and allowable exceptions for Dupixent (dupilumab) by strength/form and supply interval for covered benefit plans administered by Cigna companies.

Policy Summary

PayerCigna

PolicyDupixent (dupilumab) — Drug Quantity Management Policy (Per Days)

Policy CodePolicy N/A

Change TypeRevised induction override quantitiesclarified approval durations

Effective DateN/A

Next Review DateAug 13, 2025

Key ActionSubmit prior authorization with documentation showing no Dupixent claims in the past 130 days to request a one-time induction override.

SourceLink

POLICY UPDATE CHANGES

One-time override quantities were expanded for Dupixent 200 mg and 300 mg presentations to specify milligram and syringe/pen counts and to add chronic spontaneous urticaria (200 mg) and additional indications (300 mg) to the induction dosing override.

Policy statement clarified that all approvals are for 1 year unless noted, and 'one-time' approvals are 30 days.

2 syringesRetail 100 mg per 28 days

6 syringesHome 100 mg per 84 days

2 pensRetail 200/300 mg per 28 days

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.

Coverage Criteria

Quantity limits and allowable overrides

Covered with quantity limits; exceptions covered as medically necessary when the criteria below are met.

Dupixent 100 mg/0.67 mL: Retail maximum: 2 syringes (200 mg) per 28 days; Home delivery maximum: 6 syringes (600 mg) per 84 days.

No induction overrides specified for this presentation.

Dupixent 200 mg/1.14 mL pens and syringes

200 mg induction override: If initiating therapy at induction dosing for asthma, atopic dermatitis, or chronic spontaneous urticaria and there are no Dupixent claims in the past 130 days, approve a one-time override: retail 800 mg (4 pens/syringes) or home delivery 1,600 mg (8 pens/syringes).absence of Dupixent claims in past 130 days
Retail quantity covers loading (400 mg) plus maintenance for 28 days; home delivery covers loading plus maintenance for 84 days.

Dupixent 300 mg/2 mL pens and syringes

300 mg induction override: If initiating therapy at induction dosing for asthma, atopic dermatitis, bullous pemphigoid, chronic spontaneous urticaria, or prurigo nodularis and there are no Dupixent claims in the past 130 days, approve a one-time override: retail up to 1,200 mg (4 pens/syringes) or home delivery up to 2,400 mg (8 pens/syringes).absence of Dupixent claims in past 130 days
Retail quantity provides initial 600 mg loading dose plus maintenance for 28 days; home delivery provides for loading plus maintenance for 84 days.
Eosinophilic esophagitis - 300 mg presentation: For eosinophilic esophagitis, approve 1,200 mg (4 pens/syringes) per 28 days at retail and 3,600 mg (12 pens/syringes) per 84 days at home delivery.absence of Dupixent claims in past 130 days
Policy specifies these higher quantities for EoE induction/maintenance.

Any exception to the listed quantity limits not meeting the specified criteria is considered not medically necessary.

Requests that exceed the listed quantity limits and do not meet the documented exception criteria are considered not medically necessary and will be denied. Quantity limits for each Dupixent strength/form are specified in the policy and exceptions must meet the criteria outlined to be approved.

Coding and Claim Lookback

Drug presentations notedmixed

NDC and HCPCS not specified

Document provides strength/form and quantity limits but does not list explicit NDCs or HCPCS codes.

Claims lookback for induction

Claims lookback for inductionAbsence of claims for Dupixent in the past 130 days is required to verify initiation at induction dosing and qualify for a one-time induction override.

PurposeUsed to determine eligibility for one-time induction quantity overrides when initiating therapy.

Applies toInduction overrides for 200 mg and 300 mg presentations as specified in policy criteria.

Provider Actions and Requirements

Prior Authorization

Quantity limit prior authorization

Prior authorization is required when a requested quantity exceeds the Drug Quantity Management rule at point of service. One-time induction overrides may be applied per policy as specified for 200 mg and 300 mg strengths. Approvals provided under the Quantity Management program are generally for 1 year; one-time approvals (induction overrides) are for 30 days.

Quantity exceedance at point of sale triggers prior authorization
One-time induction overrides permitted per policy (see induction criteria for 200 mg and 300 mg strengths)
Standard approvals: 1 year; one-time approvals: 30 days

Documentation Required

Required documentation

Providers must submit requests consistent with the member's applicable benefit plan and include supporting documentation demonstrating the medical necessity for any quantity exception. Documentation should include clinical indication, prior medication or claim history (e.g., absence of Dupixent claims in the past 130 days when requesting an induction override), dosing rationale (including induction/loading dose details), and relevant clinical notes or test results.

Background

Dupixent (dupilumab) is an interleukin-4 receptor alpha antagonist indicated for multiple type 2 inflammatory conditions, including asthma, atopic dermatitis, chronic rhinosinusitis with nasal polyposis, eosinophilic esophagitis, chronic spontaneous urticaria, bullous pemphigoid, prurigo nodularis, and COPD with an eosinophilic phenotype. Dosing varies by indication, age, and weight and may include an induction (loading) dose followed by maintenance subcutaneous injections at specified intervals. The policy defines specific quantity limits by strength and presentation (for example, 100 mg/0.67 mL: retail 2 syringes [200 mg] per 28 days; home delivery 6 syringes [600 mg] per 84 days) and also describes allowable one-time induction overrides when criteria are met (such as absence of a Dupixent claim in the prior 130 days) to accommodate initiation dosing.

Definitions

Dosing frequency abbreviations

Q2WOnce every 2 weeks.

Q4WOnce every 4 weeks.

QWOnce weekly.

Initial Therapy Criteria (Induction Overrides)

Induction overrides

One-time induction overrides for initiation of therapy when no Dupixent claims in past 130 days.

200 mg induction override: If initiating therapy for asthma, atopic dermatitis, or chronic spontaneous urticaria with no Dupixent claim in the past 130 days, approve a one-time override: retail 800 mg (4 pens/syringes) or home delivery 1,600 mg (8 pens/syringes).absence of Dupixent claims in past 130 days

Retail quantity covers the initial 400 mg loading dose followed by 200 mg Q2W for 28 days; home delivery provides loading plus maintenance for 84 days.

300 mg induction override: If initiating therapy for asthma, atopic dermatitis, bullous pemphigoid, chronic spontaneous urticaria, or prurigo nodularis with no Dupixent claim in the past 130 days, approve a one-time override: retail up to 1,200 mg (4 pens/syringes) or home delivery up to 2,400 mg (8 pens/syringes).absence of Dupixent claims in past 130 days

Retail quantity provides the initial 600 mg loading dose followed by 300 mg Q2W for 28 days; home delivery provides loading plus maintenance for 84 days.

Continuation Criteria

Approval duration

Standard approvals are provided for ongoing therapy.

Approval duration: All approvals will be provided for 1 year in duration unless noted otherwise; 'one-time' approvals are provided for 30 days.

Exceptions to duration will be specified where applicable.

Quantity Limits by Presentation

Dupixent 100 mg/0.67 mL syringe — quantity limits

PresentationDupixent 100 mg / 0.67 mL syringe.

Retail maximum (per 28 days)2 syringes (200 mg).

Home delivery maximum (per 84 days)6 syringes (600 mg).

Dupixent 100 mg/0.67 mL syringe — home delivery limit

PresentationDupixent 100 mg / 0.67 mL syringe.

Home delivery maximum (per 84 days)6 syringes (600 mg).

Retail maximum (per 28 days)2 syringes (200 mg).