Nucala (mepolizumab subcutaneous injection - GlaxoSmithKline) — Cigna

Asthma

Initial criteria

age ≥ 6 years
Patient has blood eosinophil level ≥ 150 cells/μL within previous 6 weeks OR prior to treatment with Nucala or another monoclonal antibody therapy that may alter eosinophil levels
Patient has received ≥ 3 consecutive months of combination therapy with BOTH an inhaled corticosteroid AND at least one additional asthma controller or maintenance medication
Asthma is uncontrolled or was uncontrolled at baseline as defined by ONE of: (a) ≥ 2 exacerbations requiring systemic corticosteroids in previous year OR (b) ≥ 1 exacerbation requiring hospitalization, emergency department, or urgent care visit in previous year OR (c) FEV1 < 80% predicted OR (d) FEV1/FVC < 0.80 OR (e) worsening upon tapering of systemic corticosteroids
Prescribed by or in consultation with an allergist, immunologist, or pulmonologist

Patient has already received ≥ 6 months of therapy with Nucala
Patient continues to receive therapy with one inhaled corticosteroid or one inhaled corticosteroid-containing combination inhaler
Patient has responded to therapy as determined by prescriber (e.g., decreased exacerbations, symptoms, hospitalizations, or corticosteroid use)

initial 6 months; reauth 1 year