AmeriHealth recently changed how we cover specialty drugs Fasenra® (benralizumab) and Nucala® (mepolizumab). When these drugs were first approved by the U.S. Food & Drug Administration (FDA), they required administration by a health care provider and were 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.
As of January 1, 2021, Fasenra and Nucala are only covered under the pharmacy benefit.
What does this mean for your AmeriHealth patients?
In November, AmeriHealth mailed letters to all members who have received these drugs in the past twelve months. The letter explained how this change affects them.
For members who are new to treatment as of January 1, 2021, these drugs are only covered under the member's pharmacy benefit.
We also mailed letters to all providers who have prescribed Fasenra or Nucala in the past twelve months to AmeriHealth members. These letters provided 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.
For providers whose patients require a new prescription and have prescription drug coverage through FutureScripts®, Optum Specialty Pharmacy® will contact these providers and members to support a successful transition.
Policy update
Fasenra and Nucala were added to AmeriHealth Claim Payment Policy #08.00.78ag: Self-Administered Drugs, which went into effect January 1, 2021.
To view this policy, visit our Medical and Claim Payment Policy Portal.