MedicaidPrior AuthMedium impact
New Dupixent Prior Authorization Clinical Criteria Requirements pdf
Connecticut Medicaid (HUSKY Health)·CT · Dermatology, Pulmonology, Allergy & Immunology +1 more·Prior Authorization
Effective date
May 4, 2022
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid (HUSKY) is implementing new prior authorization requirements for Dupixent injections effective May 4, 2022. Providers must meet specific clinical criteria for atopic dermatitis, asthma, and chronic rhinosinusitis patients and submit a new PA form, with approvals valid for 12 months.
Action Required
By May 4, 2022: Providers prescribing Dupixent must obtain prior authorization using the new Dupixent PA form available at ctdssmap.com before prescribing. Verify patients meet age and clinical criteria (failed conventional treatments for dermatitis, eosinophilic asthma with steroid dependence, or failed corticosteroids/surgery for nasal polyposis). Fax completed forms per instructions or email medical necessity letters to Rx.LMN@ct.gov if criteria not met. Update workflow to renew PAs every 12 months.