Nucala (mepolizumab) — Point32Health

Initial criteria

• Documented diagnosis of chronic rhinosinusitis with nasal polyps
• Patient age ≥ 18 years
• Prescribed by or in consultation with an allergist, immunologist, or otolaryngologist
• Documentation of one of the following: patient will be concurrently treated with an intranasal corticosteroid OR contraindication to intranasal corticosteroids
• The patient will not be concurrently treated with an alternative biologic for nasal polyps

Reauthorization criteria

• Documented diagnosis of chronic rhinosinusitis with nasal polyps
• Patient age ≥ 18 years
• Prescribed by or in consultation with an allergist, immunologist, or otolaryngologist
• Documentation of one of the following: patient is concurrently treated with intranasal corticosteroids OR contraindication to intranasal corticosteroids
• Documentation the patient has experienced a therapeutic response as defined by at least one of the following: adequate sinus ventilation and drainage OR control of mucosal inflammation and edema OR reduction in exacerbation
• The patient will not be concurrently treated with an alternative biologic for nasal polyps

Approval duration

initial 6 months; reauth 12 months