Generic Brand HICL GCN Exception/Other

ABROCITINIB

CIBINQO

47767

 

 

Guidelines for Use

INITIAL CRITERIA (NOTE:  FOR RENEWAL CRITERIA SEE BELOW)

Our guideline named abrocitinib (cibinqo) requires the following rule(s) be met for approval:

  1. You have moderate to severe atopic dermatitis (a type of skin condition)
  2. You are 18 years of age or older
  3. You had a trial of a high or super-high potency topical corticosteroid (such as triamcinolone acetonide, fluocinonide, clobetasol propionate, halobetasol propionate) AND one non-steroidal topical immunomodulating agent (such as Eucrisa, Opzelura, pimecrolimus, tacrolimus)
  4. You had a trial of or contraindication to Rinvoq (upadacitinib)

RENEWAL CRITERIA

Our guideline named ABROCITINIB (Cibinqo) requires the following rule(s) be met for renewal:

  1. You have moderate to severe atopic dermatitis (a type of skin condition)
  2. You have experienced or maintained improvement in at least TWO of the following:
    1. Intractable pruritus (a type of skin condition)
    2. Cracking and oozing/bleeding of affected skin
    3. Impaired activities of daily living

Rationale

Ensure appropriate diagnostic, utilization and safety criteria are used for the management of requests for Cibinqo.

Indications for Use

Cibinqo is a janus kinase (JAK) inhibitor indicated for the treatment of adults with refractory, moderate-to-severe atopic dermatitis whose disease is not adequately controlled with other systemic drug products, including biologics, or when use of those therapies is inadvisable.

Dosage and Administration

The recommended dosage of Cibinqo is 100 mg orally once daily. If an adequate response is not achieved with Cibinqo 100mg orally daily after 12 weeks, consider increasing dosage to 200 mg orally once daily. Discontinue therapy if inadequate response is seen after dosage increase to 200 mg once daily.

References

Cibinqo [Prescribing Information]. New York, NY: Pfizer Labs; January 2022.


Created: 3/1/2022 5:22:05 PM
Effective: 4/18/22

Last Modified: Tuesday, June 27, 2023