Nucala_Precertification_Request
Aetna precertification request form to collect patient, prescriber, dispensing, diagnosis, and clinical information for authorization review for Nucala (mepolizumab) in multiple labeled indications (asthma, CRSwNP, EGPA, HES). It defines required fields and clinical questions to support prior authorization review; it does not itself state coverage criteria or billing codes.
No material changes — this is an administrative precertification form with no material clinical/coverage changes.
Policy overview & purpose
This is an Aetna precertification request form titled Nucala (mepolizumab) Injectable Medication Precertification Request used to collect patient, prescriber, dispensing/administration, product, diagnosis (ICD code) and indication-specific clinical information needed for utilization review across labeled indications including asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), eosinophilic granulomatosis with polyangiitis (EGPA), and hypereosinophilic syndrome (HES).