Fasenra — CareFirst (Caremark)

Initial criteria

• Member is age ≥ 6 years
• Authorization of 6 months may be granted for members who have previously received a biologic drug (e.g., Dupixent, Nucala) indicated for asthma in the past year
• Member has a baseline blood eosinophil count ≥ 150 cells per microliter OR is dependent on systemic corticosteroids
• Member has uncontrolled asthma as demonstrated by at least one of the following within the past year: two or more exacerbations requiring oral or injectable corticosteroid treatment, one or more exacerbations resulting in hospitalization or emergency medical care visits, or poor symptom control (frequent symptoms or reliever use, activity limited by asthma, night waking due to asthma)
• Member has inadequate asthma control despite current treatment with both of the following medications at optimized doses: high-dose inhaled corticosteroid AND additional controller (long-acting beta2-agonist, long-acting muscarinic antagonist, leukotriene modifier, or sustained-release theophylline)
• Member will continue to use maintenance asthma treatments (inhaled corticosteroid and additional controller) in combination with Fasenra
• Medication must be prescribed by or in consultation with an allergist/immunologist or pulmonologist

Reauthorization criteria

• Member is age ≥ 6 years
• Asthma control has improved on the requested medication as demonstrated by at least one of the following: reduction in frequency and/or severity of symptoms and exacerbations, or reduction in daily maintenance oral corticosteroid dose
• Member will continue to use maintenance asthma treatments (inhaled corticosteroid and additional controller) in combination with the requested medication

Approval duration

Initial: 6 months; Reauthorization: 12 months