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NucalaMedical 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