Effective for dates of service beginning August 1, 2016, Harvard Pilgrim has developed a new medical policy for the use of the drug Nucala. Nucala, which was approved by the U.S. Food and Drug Administration in November 2015, is an interleukin-5 antagonist monoclonal antibody indicated for add-on maintenance treatment of severe eosinophilic asthma in patients ages 12 and older.
Harvard Pilgrim considers Nucala medically necessary when prescribed by an allergist, immunologist, or pulmonologist, as an add-on maintenance treatment for members ages 12 and older with severe eosinophilic asthma who:
- Have documented eosinophil levels greater than 150 cells/µL; and
- Have inadequately controlled asthma symptoms with failure or intolerance of all other asthma medications over a three-month period, including, but not limited to:
- Inhaled corticosteroids
- Long-acting bronchodilators
- Combination long-acting bronchodilator and corticosteriod
- Oral corticosteroids
- Leukotriene modifiers
For complete information, please refer to the Nucala Medical Policy.