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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

July 2016

New Medical Policy for Nucala


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.

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