Nucala (mepolizumab) — United Healthcare
Chronic obstructive pulmonary disease (COPD) with eosinophilic phenotype
Initial criteria
- All of the following: patient established on therapy with Nucala under an active UnitedHealthcare medical benefit prior authorization for COPD AND documentation of positive clinical response to Nucala therapy AND will continue as add-on maintenance therapy AND not receiving Nucala in combination with anti-interleukin 5 therapy [Cinqair, Fasenra], anti-IgE therapy [Xolair], anti-interleukin 4 therapy [Dupixent], or TSLP inhibitor therapy [Tezspire]
- OR all of the following: diagnosis of COPD AND eosinophilic phenotype AND used in combination with maintenance therapy [Advair/AirDuo, Bevespi Aerosphere, Breo Ellipta, Symbicort, Trelegy Ellipta] AND not receiving Nucala in combination with agents listed above
Reauthorization criteria
- Documentation of positive clinical response to Nucala therapy AND used in combination with maintenance therapy [Advair/AirDuo, Bevespi Aerosphere, Breo Ellipta, Symbicort, Trelegy Ellipta] AND not receiving Nucala in combination with anti-interleukin 5 therapy, anti-IgE therapy, anti-interleukin 4 therapy, or TSLP inhibitor therapy
Approval duration
12 months