Tezspire (tezepelumab-ekko subcutaneous injection) — Cigna

Asthma

Initial criteria

Patient age ≥ 12 years; 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) patient experienced ≥ 2 asthma exacerbations requiring systemic corticosteroids in the previous year; OR (b) patient experienced ≥ 1 asthma exacerbation requiring hospitalization, emergency department, or urgent care visit in the previous year; OR (c) forced expiratory volume in 1 second (FEV1) < 80% predicted; OR (d) FEV1/forced vital capacity (FVC) < 0.80; OR (e) asthma worsens upon tapering of oral corticosteroid therapy; 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 Tezspire; AND
Patient continues therapy with one inhaled corticosteroid or one inhaled corticosteroid-containing combination inhaler; AND
Patient has responded to therapy as determined by the prescriber (e.g., decreased asthma exacerbations, improved symptoms, improved lung function, reduced hospitalizations or corticosteroid use)

initial 6 months; reauth 1 year