Nucala (mepolizumab subcutaneous injection - GlaxoSmithKline) — Cigna

Initial criteria

• age ≥ 18 years
• Patient has blood eosinophil level ≥ 300 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 ALL inhaled LABA, LAMA, and ICS OR has received ≥ 3 consecutive months of LABA and LAMA and has contraindication to ICS
• Patient has ≥ 2 COPD exacerbations requiring systemic corticosteroid ± antibiotic in previous 12 months OR ≥ 1 COPD exacerbation requiring hospitalization in previous 12 months
• Prescribed by or in consultation with an allergist, immunologist, or pulmonologist

Reauthorization criteria

• Patient has already received ≥ 6 months of therapy with Nucala
• Patient continues to receive combination therapy with inhaled LABA and LAMA

Approval duration

initial 6 months; reauth 1 year