WHA

Anzupgo (delgocitinib)

Indications for Prior Authorization

Anzupgo (delgocitinib)
  • For diagnosis of Chronic Hand Eczema (CHE)
    Indicated for the topical treatment of moderate to severe chronic hand eczema (CHE) in adults who have had an inadequate response to, or for whom topical corticosteroids are not advisable.

Criteria

Anzupgo

For state-mandated plans in Illinois or other states where applicable: Step therapy requirements do NOT apply. Beginning January 1, 2026, step therapy requirements or use of the authorization of alternative covered medications in a manner that effectively creates a step therapy requirement will not be imposed.

Prior Authorization (Initial Authorization)

Length of Approval: 6 Month(s)
For diagnosis of Chronic Hand Eczema (CHE)

  • Diagnosis of moderate to severe chronic hand eczema (CHE)
    • AND
  • Patient is 18 years of age or older
    • AND
  • Prescribed by or in consultation with one of the following:
    • Dermatologist
    • Allergist/Immunologist
    AND
  • Trial and failure of a minimum 30-day supply (14-day supply for topical corticosteroids), contraindication, or intolerance to BOTH of the following [1-3]:
    • Medium or higher potency topical corticosteroid
    • Generic calcineurin inhibitor (e.g., tacrolimus ointment)
    AND
  • Not used in combination with other Janus kinase (JAK) inhibitors or potent immunosuppressants (e.g., azathioprine or cyclosporine)
Anzupgo

Prior Authorization (Reauthorization)

Length of Approval: 12 Month(s)
For diagnosis of Chronic Hand Eczema (CHE)

  • Patient demonstrates positive clinical response to therapy (e.g., erythema, scaling, hyperkeratosis, fissures) [1-3]
    • AND
  • Not used in combination with other JAK inhibitors or potent immunosuppressants (e.g., azathioprine or cyclosporine)

  • Guideline ID
    GL-486368

  • Formulary
    Premium

  • Effective date
    Jan 1, 2026

  • P&T approval date
    Sep 17, 2025

P & T Revisions

1970-01-01, 2025-12-18, 2025-09-11

  1. Anzupgo prescribing information. LEO Pharma Inc. Madison, NJ. July 2025.
  2. Bissonnette R, Warren RB, Pinter A, et al. Efficacy and safety of delgocitinib cream in adults with moderate to severe chronic hand eczema (DELTA 1 and DELTA 2): results from multicentre, randomised, controlled, double-blind, phase 3 trials. Lancet. 2024; 404(10451):461-473.
  3. Thyssen JP, Schuttelaar MLA, Alfonso JH, et al. Guidelines for diagnosis, prevention, and treatment of hand eczema. Contact Dermatitis. 2022; 86(5):357-378.
  4. Sidbury R, Alikhan A, Bercovitch L, et al. Guidelines of care for the management of atopic dermatitis in adults with topical therapies. J Am Acad Dermatol. 2023;89(1):e1-e20.
  • 2025-12-18: no criteria changes, added IL statute operational note
  • 2025-09-11: New program