Fasenra (benralizumab) — United Healthcare

Initial criteria

• One of the following:
• 1) All of the following:
• - Patient has been established on therapy with Fasenra under an active UnitedHealthcare medical benefit prior authorization for the treatment of severe asthma
• - AND Documentation of positive clinical response to Fasenra therapy
• - AND Fasenra will be used in combination with maintenance therapy [e.g., Advair/AirDuo (fluticasone/salmeterol), Breo Ellipta (fluticasone furoate/vilanterol), Symbicort (budesonide/formoterol), Trelegy Ellipta (fluticasone furoate/umeclidinium/vilanterol)]
• - AND Patient is not receiving Fasenra in combination with any of the following for the same indication: Anti-interleukin 5 therapy [e.g., Cinqair (resilizumab), Nucala (mepolizumab)], Anti-IgE therapy [e.g., Xolair (omalizumab)], Anti-interleukin 4 therapy [e.g., Dupixent (dupilumab)], Thymic stromal lymphopoietin (TSLP) inhibitor therapy [e.g., Tezspire (tezepelumab)]
• OR
• 2) All of the following:
• - Diagnosis of severe asthma
• - AND Fasenra will be used in combination with maintenance therapy [e.g., Advair/AirDuo (fluticasone/salmeterol), Breo Ellipta (fluticasone furoate/vilanterol), Symbicort (budesonide/formoterol), Trelegy Ellipta (fluticasone furoate/umeclidinium/vilanterol)]
• - AND Asthma is an eosinophilic phenotype
• - AND Patient is not receiving Fasenra in combination with any of the following for the same indication: Anti-interleukin 5 therapy [e.g., Cinqair (resilizumab), Nucala (mepolizumab)], Anti-IgE therapy [e.g., Xolair (omalizumab)], Anti-interleukin 4 therapy [e.g., Dupixent (dupilumab)], Thymic stromal lymphopoietin (TSLP) inhibitor therapy [e.g., Tezspire (tezepelumab)]

Reauthorization criteria

• All of the following:
• - Documentation of positive clinical response to Fasenra therapy
• - AND Fasenra will be used in combination with maintenance therapy [e.g., Advair/AirDuo (fluticasone/salmeterol), Breo Ellipta (fluticasone furoate/vilanterol), Symbicort (budesonide/formoterol), Trelegy Ellipta (fluticasone furoate/umeclidinium/vilanterol)]
• - AND Patient is not receiving Fasenra in combination with any of the following for the same indication: Anti-interleukin 5 therapy [e.g., Cinqair, Nucala], Anti-IgE therapy [e.g., Xolair], Anti-interleukin 4 therapy [e.g., Dupixent], Thymic stromal lymphopoietin inhibitor therapy [e.g., Tezspire]

Approval duration

12 months