Nucala® (mepolizumab)

Nucala (mepolizumab) is covered only for its FDA‑approved indications—add‑on maintenance for severe eosinophilic asthma (age ≥6), EGPA (adults), HES (age ≥12 with ≥6 months disease and FIP1L1‑PDGFRα‑negative), and chronic rhinosinusitis with nasal polyps (adults)—and not for non‑approved uses. Coverage requires indication‑specific documentation (eosinophil thresholds: ≥150 cells/µL for asthma/EGPA within specified windows; ≥1,000 cells/µL for HES), required prior therapies/durations (≥3 months ICS+controller for asthma; ≥4 weeks systemic steroids for EGPA; ≥4 weeks prior HES therapy; ≥4 weeks intranasal steroids and prior systemic steroid course/surgery/contraindication for CRSwNP), specialist prescribing/consultation, age limits, and objective clinical response for reauthorization.

"Blood eosinophil count documentation: Severe asthma — greater than or equal to 150 cells per microliter within the previous 6 weeks or prior to treatment with Nucala or another monoclonal antibody ..."