Nucala (mepolizumab) — United Healthcare

Initial criteria

• All of the following: patient established on Nucala under an active UnitedHealthcare medical benefit prior authorization for HES 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 TSLP inhibitor therapy [Tezspire (tezepelumab)]
• OR all of the following: diagnosis of HES ≥ 6 months ago AND no identifiable non-hematologic secondary cause of HES (e.g., drug hypersensitivity, parasitic helminth infection, HIV infection, non-hematologic malignancy) 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