Medicare AdvantagePrior AuthHigh impact
Asthma Interleukin Inhibitors (Cinqair®, Nucala™, Fasenra®) (Revised)
Humana·Pulmonology, Allergy & Immunology, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jul 21, 2026
Summary
This is a revised Medicare Advantage prior authorization policy for asthma interleukin inhibitors (Cinqair, Nucala, Fasenra) effective January 1, 2026, with updates as of July 22, 2026. The policy establishes specific clinical criteria for coverage across five indications: severe eosinophilic asthma, EGPA, HES, chronic rhinosinusitis with nasal polyposis, and eosinophilic COPD. Billing teams must verify all prior authorization requirements before dispensing these specialty medications.
Action Required
By January 1, 2026: Billing team must implement prior authorization process for all Cinqair (reslizumab), Nucala (mepolizumab), and Fasenra (benralizumab) claims submitted to Humana Medicare Advantage plans. Update billing system to require documentation of: (1) diagnosis confirmation from the five covered indications, (2) baseline eosinophil counts meeting specified thresholds (≥150 cells/μL at initiation OR ≥300 cells/μL in prior 12 months for asthma/COPD; ≥10% of total leukocytes for EGPA), and (3) failure of prior standard therapy (maximum inhaled corticosteroids + LABA, oral corticosteroids, or intranasal corticosteroids as applicable). Pharmacy staff must submit prior authorization requests to Humana before dispensing. Do not process claims without documented prior authorization approval—claims will be denied. Verify current policy version at https://dctm.humana.com/Mentor/Web/ before processing each request, as policy is subject to updates.