Nucala — Cigna

Initial criteria

• Age ≥ 18 years
• Diagnosis of chronic rhinosinusitis with nasal polyps as evidenced by direct examination, endoscopy, or sinus CT scan
• Two or more of the following symptoms for ≥ 6 months: nasal congestion, nasal obstruction, nasal discharge, and/or reduction/loss of smell
• Received at least 4 weeks of therapy with an intranasal corticosteroid AND will continue concomitant intranasal corticosteroid therapy with Nucala
• Has ONE of the following: received at least one course of systemic corticosteroid for ≥ 5 days within the previous 2 years OR has contraindication to systemic corticosteroid therapy OR had prior surgery for nasal polyps
• Prescribed by or in consultation with an allergist, immunologist, or an otolaryngologist (ENT physician specialist)

Reauthorization criteria

• Has already received at least 6 months of therapy with Nucala
• Continues to receive intranasal corticosteroid therapy
• Responded to therapy as determined by the prescriber (e.g., reduced nasal polyp size, improved nasal congestion, reduced sinus opacification, decreased sino-nasal symptoms, improved sense of smell)

Approval duration

initial 6 months, reauth 1 year