Immunologicals - Nucala Prior Authorization Policy
Cigna pharmacy prior authorization policy for Nucala (mepolizumab subcutaneous injection) detailing coverage criteria for FDA‑approved indications (asthma, COPD, CRSwNP, EGPA, HES), not‑covered uses, prescriber requirements, approval durations, and prior therapy/eosinophil thresholds.
Chronic Obstructive Pulmonary Disease (COPD) indication and approval criteria were added to the policy.
CRSwNP criteria updated to require symptoms for at least 8 weeks and diagnosis duration of at least 6 months; intranasal corticosteroid trial changed to 4 weeks and prior systemic corticosteroid requirement limited to previous year.
EGPA initial approval duration and eosinophil timing clarified.
Asthma eosinophil timing clarified to require ≥ 150 cells/µL within the previous 6 weeks or prior to treatment with a monoclonal antibody that may alter eosinophil levels.
Hypereosinophilic Syndrome (HES) eosinophil timing clarified and initial approval duration set to 8 months.
Examples of monoclonal antibody therapies that may alter blood eosinophil levels were expanded to include Ebglyss and Nemluvio.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.