Fasenra — Highmark
Eosinophilic Granulomatosis with Polyangiitis (EGPA)
Initial criteria
- Member will be receiving standard of care while on therapy with glucocorticoid treatment (e.g. prednisone or prednisolone), with or without immunosuppressive therapy (e.g. cyclosporine, leflunomide, azathioprine etc.)
Reauthorization criteria
- Request is for the 30 mg/mL autoinjector AND prescriber attests one of the following:
- • Member has experienced reduction in the frequency and/or severity of relapses OR
- • Member has experienced a reduction or discontinuation of doses of corticosteroids and/or immunosuppressant OR
- • Member has experienced disease remission OR
- • Member has experienced a reduction in severity or frequency of EGPA-related symptoms
Approval duration
12 months