Harvard Pilgrim Health Care Home
  Learn more.
  Sign up for HPHConnect.
Medical Management
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Office Support
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
Print    Text Size

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.

Email this article to a colleague   

Network Matters Archives

Download printer-friendly version


Substance Abuse Materials Now Available Online


Medical Policy Changes for Injectable and Infusible Drugs

Coverage of Vitamin B12 Screening and Testing

Coverage of Tumor Treatment Field Device for Glioblastoma

Briviact Covered With Prior Authorization

Nuplazid Covered With Prior Authorization

New Medical Policy for H. Pylori Testing

New Medical Policy for Nucala

Tier Increase for Apidra and Apidra SoloSTAR on the Premium Formulary

Tier Increase for Edecrin on the Premium Formulary

Diagnosing and Treating Depression in Older Adults

P&T Committee Meeting Update

Specialty Pharmacy Update


Reminder: Keep Panel Status and Demographic Information Up to Date


Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator