Nucala — United Healthcare

Hypereosinophilic Syndrome (HES)

Initial criteria

Baseline (pre-mepolizumab treatment) blood eosinophil level ≥1000 cells/µL within the past 4 weeks
Patient is currently receiving a stable dose of background HES therapy (e.g., oral corticosteroid, immunosuppressor, or cytotoxic therapy)
Patient is not receiving Nucala in combination with anti-interleukin-5 therapy [e.g., Cinqair (resilizumab), Fasenra (benralizumab)], anti-IgE therapy [e.g., Xolair (omalizumab)], anti-interleukin-4 therapy [e.g., Dupixent (dupilumab)], or thymic stromal lymphopoietin (TSLP) inhibitor [e.g., Tezspire (tezepelumab)]
Prescribed by one of the following: Allergist, Immunologist, Hematologist, Cardiologist, or Pulmonologist

Documentation of positive clinical response to Nucala therapy as demonstrated by at least one of the following: reduction in frequency of HES flares OR maintenance or reduction in background HES therapy requirements
Patient is not receiving Nucala in combination with anti-interleukin-5 therapy [e.g., Cinqair (resilizumab), Fasenra (benralizumab)], anti-IgE therapy [e.g., Xolair (omalizumab)], anti-interleukin-4 therapy [e.g., Dupixent (dupilumab)], or thymic stromal lymphopoietin (TSLP) inhibitor [e.g., Tezspire (tezepelumab)]

12 months