Spevigo® (Spesolimab-Sbzo) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers IV Spevigo for GPP flares (maximum two FDA‑labeled doses per flare, authorization ≤21 days) and subcutaneous Spevigo for flare prevention in patients who meet specified initial and continuation criteria, but considers Spevigo unproven/not medically necessary for other conditions (e.g., atopic dermatitis, Crohn’s, hidradenitis suppurativa, palmoplantar pustulosis, plaque psoriasis, ulcerative colitis) and prohibits use with other targeted immunomodulators for the same indication. Coverage requires dermatologist prescribing, strict diagnostic documentation of GPP (primary sterile pustules on an erythematous base, non‑acral/non‑plaque distribution), objective severity/response measures (GPPPGA scores, BSA, labs), adherence to FDA dosing and age/weight limits, prescriber attestations where specified, and specified authorization durations/limits.

"Intravenous Spevigo for treatment of generalized pustular psoriasis (GPP) flares when all of the following are met: diagnosis of GPP; patient has a GPP flare; Spevigo is dosed according to U."