Fasenra (benralizumab subcutaneous injection – AstraZeneca) — Cigna

Initial criteria

• Patient age ≥ 18 years; AND
• Patient has active, non-severe disease; AND
• Patient meets BOTH of the following (a and b): a) Patient is currently receiving a systemic corticosteroid (e.g., prednisone) and has been on therapy for a minimum of 4 weeks; AND b) Patient meets ONE of the following [(1) or (2)]: (1) Patient has a blood eosinophil level ≥ 150 cells per microliter within the previous 4 weeks; OR (2) Patient had a blood eosinophil level ≥ 150 cells per microliter prior to treatment with Fasenra or another monoclonal antibody therapy that may alter blood eosinophil levels; AND
• Medication is prescribed by or in consultation with an allergist, immunologist, pulmonologist, or rheumatologist.

Reauthorization criteria

• Patient has already received at least 9 months of therapy with Fasenra; AND
• Patient has responded to therapy as determined by the prescriber (e.g., reduced rate of relapse, corticosteroid dose reduction, reduced eosinophil levels).

Approval duration

initial 9 months; renewal 1 year