AmeriHealth is changing how we cover specialty drugs Fasenra® (benralizumab) and Nucala® (mepolizumab). These drugs are U.S. Food & Drug Administration-approved to treat severe asthma and are currently covered under the medical benefit. In 2019, these drugs became available as self-administered injections. It is now more appropriate for plans to cover Fasenra and Nucala as a pharmacy benefit.
Effective January 1, 2021, Fasenra and Nucala will only be covered under the pharmacy benefit.
What does this mean for your AmeriHealth patients?
In November, AmeriHealth will mail letters to all members who have received these drugs in the past twelve months. The letter will explain how this upcoming change will affect them.
For members who will be new to treatment on or after January 1, 2021, these drugs will only be covered under the member’s pharmacy benefit.
In November, we will mail letters to all providers who have prescribed Fasenra or Nucala in the past twelve months to AmeriHealth members. These letters will provide detailed information about this change, such as:
- how members who are currently receiving these drugs are affected;
- the process for managing existing authorizations and obtaining new authorizations;
- writing new prescriptions for these drugs so pharmacy benefits managers can fulfill requests;
- medication delivery options – member’s home or provider’s office.
Fasenra and Nucala will be added to AmeriHealth Claim Payment Policy #08.00.78ag: Self-Administered Drugs, which will become effective January 1, 2021.
To view this policy, visit our Medical Policy Portal.