Monoclonal Antibody for Asthma Prior Authorization Updates Set for April 6, 2021

Published on
February 11, 2021

Fasenra (benralizumab) and Nucala (mepolizumab) are monoclonal antibody drugs approved for severe asthma treatment. On April 6, 2021, HHSC will make the following changes to the prior authorization criteria for Monoclonal Antibody Agents (PDF) to enhance appropriate utilization per the US Food and Drug Administration’s approved indications and dosing.

Changes include:

  • For Fasenra:
    1. For question #6, HHSC will increase the look-back period from 84 days to 180 days, allowing the client to receive the first maintenance dose (the fourth dose) up to 180 days from the treatment initiation date.
    2. For questions #7 and #8, HHSC will revise dosing criteria by adding the exact dose per day
  • For Nucala (mepolizumab):
    1. HHSC will remove the generic code number (GCN) for the vial formulation. Based on the manufacturer’s information, healthcare providers must administer the Nucala vial as it is not appropriate for patient self-administration. Nucala vials are available as a clinician-administered drug benefit.
  • Monoclonal Antibody Agents for Asthma clinical prior authorization is optional for Medicaid MCOs. The Pharmacy Clinical Prior Authorization Assistance Chart (PDF) shows the prior authorization each MCO uses and how those authorizations relate to the authorizations used for processing fee-for-service Medicaid claims. This chart is updated quarterly. Providers can also refer to the MCO Resources for links to each MCO’s list of clinical prior authorizations.