Fasenra (benralizumab subcutaneous injection – AstraZeneca) — Cigna

Asthma

Initial criteria

Patient is age ≥ 6 years; AND
Patient meets ONE of the following (a or b): a) Patient has a blood eosinophil level ≥ 150 cells/µL within the previous 6 weeks; OR b) Patient had a blood eosinophil level ≥ 150 cells/µL prior to treatment with Fasenra or another monoclonal antibody therapy that may alter blood eosinophil levels; AND
Patient has received at least 3 consecutive months of combination therapy with BOTH of the following: a) An inhaled corticosteroid; AND b) At least one additional asthma controller or asthma maintenance medication; AND
Patient has asthma that is uncontrolled or was uncontrolled at baseline as defined by ONE of the following: a) Two or more asthma exacerbations requiring systemic corticosteroids in the previous year; OR b) One or more asthma exacerbation(s) requiring hospitalization, emergency department, or urgent care visit in the previous year; OR c) FEV1 < 80% predicted; OR d) FEV1/FVC < 0.80; OR e) Asthma worsens upon tapering of oral corticosteroids; AND
Medication is prescribed by or in consultation with an allergist, immunologist, or pulmonologist.

Patient has already received at least 6 months of therapy with Fasenra; AND
Patient continues to receive therapy with one inhaled corticosteroid or one inhaled corticosteroid-containing combination inhaler.

initial 6 months; reauth 1 year