Nucala — Medical Mutual

Initial criteria

• Patient age ≥ 12 years; AND
• Diagnosis of HES ≥ 6 months; AND
• FIP1L1-PDGFRα-negative disease; AND
• No identifiable non-hematologic secondary cause; AND
• Blood eosinophil ≥ 1,000 cells/µL prior to treatment with antibody therapy that may lower eosinophils; AND
• Tried ≥ 1 other treatment for HES ≥ 4 weeks (e.g., systemic corticosteroids, hydroxyurea, cyclosporine, imatinib, pegylated-interferon); AND
• Prescribed/consult with allergist, immunologist, pulmonologist, or rheumatologist

Reauthorization criteria

• Already received ≥ 8 months of Nucala; AND
• Responded to therapy (e.g., decreased flares, improved fatigue, reduced corticosteroid need, decreased eosinophil levels)

Approval duration

8 months initial; 1 year reauth