Nucala — Medical Mutual
Asthma
Initial criteria
- Patient age ≥ 6 years; AND
- Blood eosinophil level ≥ 150 cells/µL within previous 6 weeks OR within 6 weeks prior to treatment with Nucala or another monoclonal antibody therapy that may lower eosinophil levels; AND
- Received ≥ 3 consecutive months of combination therapy with BOTH an inhaled corticosteroid AND at least one additional asthma controller/maintenance medication; AND
- Asthma uncontrolled at baseline defined by ONE: ≥ 2 exacerbations needing systemic corticosteroids in previous year OR ≥ 1 exacerbation requiring hospitalization/emergency/urgent care in previous year OR FEV1 < 80% predicted OR FEV1/FVC < 0.80 OR asthma worsens upon tapering of oral corticosteroid therapy; AND
- Prescribed by or in consultation with an allergist, immunologist, or pulmonologist
Reauthorization criteria
- Already received ≥ 6 months of Nucala therapy; AND
- Continues therapy with an inhaled corticosteroid or corticosteroid-containing combination inhaler; AND
- Responded to therapy as determined by prescriber (e.g., decreased exacerbations, decreased symptoms, decreased hospitalization/ED/urgent care visits, decreased requirement for oral corticosteroid use)
Approval duration
6 months initial; 1 year reauth