tezepelumab-ekko — Highmark

severe asthma

Initial criteria

age ≥ 12 years
Diagnosis of severe asthma (ICD-10: J45.5)
Member has ≥ 2 asthma exacerbations requiring oral or injectable corticosteroid treatment in the previous 12 months OR ≥ 1 asthma exacerbation requiring hospitalization in the previous 12 months
Inadequate symptom control despite regular treatment with medium- or high-dose inhaled corticosteroids (ICS) and at least one additional asthma controller (e.g., LABA, LTRA, or theophylline), with or without oral corticosteroids (OCS)
Member will continue treatment with medium- or high-dose ICS and at least one additional asthma controller (e.g., LABA, LTRA, or theophylline), with or without OCS, while using Tezspire

Prescriber attests that the member has decreased rescue medication or OCS use OR
Prescriber attests that the member has had a decrease in frequency of severe asthma exacerbations OR
Prescriber attests that the member has experienced an increase in pulmonary function from baseline (e.g., FEV1) OR
Prescriber attests that the member has experienced a reduction in reported asthma-related symptoms (e.g., asthmatic symptoms upon awakening, coughing, fatigue, shortness of breath, sleep disturbance, or wheezing)

12 months