Mepolizumab

This policy covers mepolizumab (Nucala) for FDA‑approved and select compendia- or literature‑supported indications, most notably severe eosinophilic asthma (≥6 years), hypereosinophilic syndrome (HES) in patients ≥12 years meeting duration/flare and eosinophil criteria, relapsing/refractory eosinophilic granulomatosis with polyangiitis (EGPA) in adults, and chronic rhinosinusitis with nasal polyps in adults. Coverage requires specified clinical criteria such as prior controller therapy and eosinophil thresholds (e.g., ≥150 cells/µL at screening or ≥300 cells/µL in the prior year for asthma; HES ≥1,000 cells/µL and ≥6 months’ duration), excludes use in younger/contraindicated patients or with other antiasthmatic biologics, excludes cases with other identifiable causes of eosinophilia, and is subject to member benefit plan and state‑specific limitations (HCSC Ohio).

"Coverage of any FDA‑approved drug when prescribed for a use recognized as safe and effective in one or more standard medical reference compendia adopted by the U."