Dupixent Insurance Denial

Page Contents:

• What is Dupixent?
• Who Needs Dupixent?
• Why Do Insurance Companies Deny Dupixent?
• What Are Your Legal Rights to Dupixent?
• How the Law Offices of Scott Glovsky Represents Clients Who Receive a Dupixent Insurance Denial

What is Dupixent?

Dupixent has been approved by the FDA as the first biologic medication for adults, as well as children over the age of six. Dupixent treats moderate to severe atopic dermatitis, given via injection every other week. Biologic drugs are genetically engineered from proteins derived from living tissues or cells. Biologics target specific parts of the immune system that are causing chronic inflammatory diseases, including atopic dermatitis, eczema, and asthma. Biologics like Dupixent address inflammatory conditions at the immune system level by blocking a protein known as interleukin (IL) from binding to cell receptors.

When the immune system fails to work as it should, ILs can be triggered to mistakenly attack the body. This can then result in chronic inflammatory conditions. Dupixent works on two different interleukins—IL-4 and IL-13. And as of November 2023, the second Phase 3 clinical trial “NOTUS” data from its manufacturers shows Dupixent reduced the incidence of severe chronic obstructive pulmonary disease (COPD) by 34%. Sanofi, one of the drug’s makers, expects to seek FDA approval for Dupixent for COPD patients by the end of 2023. As a “large molecule” drug, Dupixent must be given via injection because a topical application would be unable to penetrate the surface of the skin.  A Dupixent insurance denial could require an experienced insurance denial attorney from the Law Offices of Scott Glovsky. 

Who Needs Dupixent?

Atopic dermatitis is the most common type of eczema, affecting almost 10 million children and 16.5 million adults across the United States. Atopic dermatitis is a chronic condition that comes and goes for years, often overlapping with other types of eczema. Those who suffer from atopic dermatitis have immune systems that are overactive or disordered. This can trigger inflammation, resulting in damage to the skin barrier.

Many people with atopic dermatitis may have purple, brown, red, or gray rashes resulting from the disease. Most of those diagnosed with atopic dermatitis have had the condition since childhood—and it can be severe and chronic. The condition may taper off as a child grows up, while for others, the condition can worsen. Those with asthma or hay fever are more likely to develop atopic dermatitis.

On January 25, 2024, the FDA approved Dupixent to treat an allergic inflammation of the esophagus known as eosinophilic esophagitis (EoE) in kids age one to eleven who weigh at least 15 kg (33 pounds).

Why Do Insurance Companies Deny Dupixent?

A shot of Dupixent can cost as much as $3,354—or more, in some cases. Your insurance company may deny your prescription for Dupixent because it is not on the formulary list, or because they don’t believe the drug is medically necessary for your condition. Your physician can prepare a medical exception letter to send to the insurance company, telling it the drug is medically necessary for your condition. If the insurer still denies Dupixent, an appeal could be your next course of action.

What Are Your Legal Rights to Dupixent?

Just as you pay your medical insurance premiums every month, your insurer has certain obligations as well. It has an obligation not to deny drugs or treatments that are medically necessary for your health. It can feel overwhelming to take on a huge corporation regarding your Dupixent insurance denial. Having attorney Scott Glovsky on your side can be extremely beneficial for you and your health.

How the Law Offices of Scott Glovsky Represents Clients Who Receive a Dupixent Insurance Denial

If you’ve received a Dupixent insurance denial, attorney Scott Glovsky is ready to help you get the prescription drug you need. Your doctor may be telling you that Dupixent can significantly help your atopic dermatitis, allowing you to live your day-to-day life in the best way possible. This makes a Dupixent insurance denial frustrating and even frightening. Inappropriate drug denials are wrong—Scott Glovsky and his legal team are ready to help you get the drug you need. Contact the Law Offices of Scott Glovsky today.