Nucala (mepolizumab) — United Healthcare

Initial criteria

• All of the following: patient established on therapy with Nucala under an active UnitedHealthcare medical benefit prior authorization for EGPA AND documentation of positive clinical response to Nucala therapy AND not receiving Nucala in combination with anti-interleukin 5 therapy [Cinqair (resilizumab), Fasenra (benralizumab)], anti-IgE therapy [Xolair (omalizumab)], anti-interleukin 4 therapy [Dupixent (dupilumab)], or thymic stromal lymphopoietin (TSLP) inhibitor therapy [Tezspire (tezepelumab)]
• OR both of the following: diagnosis of EGPA AND not receiving Nucala in combination with agents listed above

Reauthorization criteria

• Documentation of positive clinical response to Nucala therapy 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