CurrentUnitedHealthcarePolicy N/A

Brinsupri (brensocatib) prior authorization

Prior authorization and notification requirements for Brinsupri (brensocatib) for treatment of non-cystic fibrosis bronchiectasis in patients aged ≥12; applies to UnitedHealthcare pharmacy benefits and affected providers submitting requests.

Policy Summary

PayerUnitedHealthcare

PolicyBrinsupri (brensocatib) prior authorization

Policy CodePolicy N/A

Change TypeNew prior authorization program

Effective DateFeb 1, 2026

Next Review DateN/A

Key ActionSubmit prior authorization for Brinsupri with documentation of non-cystic fibrosis bronchiectasis diagnosis; initial approvals issued for 12 months.

SourceLink

POLICY UPDATE CHANGES

New prior authorization program established for Brinsupri (brensocatib).

12 monthsInitial authorization duration

12 monthsReauthorization duration

≥12Age indication

Non-CF bronchiectasisIndicated diagnosis

Coverage and Clinical Criteria

Policy Summary

PayerUnitedHealthcare

PolicyBrinsupri (brensocatib) prior authorization

Policy CodePolicy N/A

Change TypeNew prior authorization program

Effective DateFeb 1, 2026

Next Review DateN/A

Key ActionSubmit prior authorization for Brinsupri with documentation of non-cystic fibrosis bronchiectasis diagnosis; initial approvals issued for 12 months.

SourceLink

On This Page

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inv-01: Initial Authorization

Covered when ALL of the following are met

Initial Authorization: Diagnosis of non-cystic fibrosis bronchiectasis

Authorization will be issued for 12 months

inv-02: Reauthorization

Covered when ALL of the following are met

Reauthorization: Documentation of a positive clinical response to Brinsupri

Authorization will be issued for 12 months

Coverage decisions may be affected by factors beyond the clinical criteria listed in this policy. State mandates, federal requirements, member-specific benefit plan coverage, and other utilization management programs can impact whether Brinsupri (brensocatib) is approved for a given member. UnitedHealthcare may also use automated approval and re-approval processes that rely on prior claim or medication history, diagnosis codes (ICD‑10), and claim logic; these processes vary by program or therapeutic class and can influence coverage outcomes.

This policy does not list discrete not medically necessary exclusions for Brinsupri. However, requests may still be denied if they do not meet program checks such as automated approval criteria, medical necessity rules, supply limits, or applicable step therapy requirements. Providers should follow the documented coverage criteria and supply required clinical information to avoid denial.

Initial Therapy Requirements

inv-11: Initial Therapy

Initial authorization rule

Initial Therapy: Diagnosis of non-cystic fibrosis bronchiectasis

Initial approval for 12 months

Reauthorization / Continuation Requirements

inv-12: Reauthorization / Continuation

Reauthorization requires evidence of continued benefit.

Continuation/Reauthorization: Documentation of a positive clinical response to Brinsupri

Reauthorization period: 12 months

Actions for Providers and Submission Guidance

Prior Authorization

Prior Authorization Required

Prior authorization is required for Brinsupri (brensocatib). Initial approvals are issued for 12 months when the diagnosis is non-cystic fibrosis bronchiectasis.

Applies to Brinsupri (brensocatib)

Step Therapy

Step Therapy Note

Step therapy or other utilization management rules may apply. Specific step requirements are not detailed in this document; check the payer's step therapy program for any applicable prerequisites prior to submission.

Documentation Required

Reauthorization Documentation

For reauthorization, documentation of a positive clinical response to Brinsupri is required. Reauthorizations are issued for 12 months.

Provide clinical notes describing symptom improvement, exacerbation frequency reduction, or other objective measures showing benefit.

Denial Risk

Denial Risks

Requests may be denied if they do not meet automated approval criteria, medical necessity checks, supply limits, step therapy requirements, or if required documentation (such as evidence of positive clinical response for reauthorization) is missing. UnitedHealthcare may also approve or deny based solely on prior claim/medication history, diagnosis codes (ICD-10), and claim logic.

Denial risk if documentation of diagnosis or clinical response is absent.
Denial risk if step therapy or supply limits are not satisfied.

Step Therapy (if applicable)

Step	Note
1	Step therapy may be in place; specific step requirements are not provided in this document.
	Use of automated approval processes and supply limits may apply per Additional Clinical Rules; individual program variation possible.

Site-of-Care and Operational Notes

Note

Site-of-care guidance not specified; automated processes and supply limits possible

No specific site-of-care restrictions are listed; the program may use automated approval processes and may impose supply limits as part of utilization management.

Background

Brinsupri (brensocatib) is a dipeptidyl peptidase 1 (DPP1) inhibitor indicated for the treatment of non‑cystic fibrosis bronchiectasis in adults and pediatric patients aged 12 years and older. This policy establishes prior authorization and reauthorization criteria for Brinsupri under UnitedHealthcare pharmacy benefits: initial approval is granted when the member has a documented diagnosis of non‑cystic fibrosis bronchiectasis and is issued for 12 months, and reauthorization requires documentation of a positive clinical response and is also issued for 12 months. Note that automated approval processes, supply limits, and step therapy may apply and can affect coverage.

Definitions and Drug Information

Brinsupri (brensocatib) — key facts

Drug nameBrinsupri (brensocatib)

Drug classDipeptidyl peptidase 1 (DPP1) inhibitor

IndicationTreatment of non-cystic fibrosis bronchiectasis

Age indicationPatients 12 years of age and older

Covered populationAdult and pediatric patients ≥12 years