CurrentCignaPolicy N/A

Fasenra Coverage Policy

Defines drug quantity limits, exceptions, and medical-necessity override criteria for Fasenra (benralizumab subcutaneous injection) for retail and home delivery, including induction dosing and EGPA-specific allowances. Approval durations and one-time override rules are specified.

Policy Summary

PayerCigna

PolicyFasenra Coverage Policy

Policy CodePolicy N/A

Change TypeQuantity limits & overrides updated

Effective Date

Next Review Date

Key ActionFor induction dosing overrides, confirm absence of Fasenra claims in the past 130 days to qualify for the one-time induction quantity allowance.

SourceLink

POLICY UPDATE CHANGES

New quantity limit of 0.5 mL (1 syringe) per 56 days at retail and home delivery for Fasenra 10 mg/0.5 mL prefilled syringes was added.

One-time overrides for patients initiating therapy at induction dosing for asthma were updated to approve for 84 days.

Override for EGPA: 1 mL per 28 days at retail and 3 mL per 84 days at home delivery for 30 mg/mL pens and prefilled syringes was added.

Policy Statement clarified that approvals are provided for 1 year in duration unless otherwise noted and that 'one-time' overrides are provided for the duration noted in criteria.

Annual Revision summary noted 'No criteria changes' for 08/04/2023.

3Product presentations with quantity rules

84 daysInduction override duration

56 days