Mepolizumab (Nucala)

Evicore covers mepolizumab (Nucala) only as add‑on maintenance therapy for individuals ≥12 years with severe eosinophilic asthma or for eosinophilic granulomatosis with polyangiitis (EGPA) and does not cover other off‑label compendial uses. Approval (12 months) requires specified eosinophil thresholds (asthma: ≥150 cells/mcL at screening or ≥300 cells/mcL in the prior year; EGPA: ≥10% or >1,000 cells/mcL), prior inadequate control on high‑dose ICS+LABA or alternative therapies/≥50% systemic steroid use for asthma, EGPA with ≥2 defining features and asthma history, current non‑smoker status, and documented reduction in relapses and/or glucocorticoid use for reauthorization.

"Add-on maintenance treatment of individuals with severe asthma having an eosinophilic phenotype (age 12 years or older)."

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