| Anthem Blue Cross (HMO, PPO, EPO) |
| Nucala (mepolizumab) |
| Drugs for the Lungs : Drugs for Asthma/COPD |
- Prior Authorization: EGPA:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 12 Month(s)
Reauthorization Required: Yes
- Quantity Limit: 1 injections per 28 day(s).
- EGPA:
Age Requirement: >= 18
Duration: 12 Month(s)
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: Unspecified
Covered by Exception: No
Dose Requirement: Unspecified
Exclusion Condition(s): Aspirin-exacerbated respiratory disease (AERD);Atopic Dermatitis;Nasal polyposis
Documented Diagnosis: Yes
- PA Applies
- Available only through Specialty Pharmacy;
For FAX form click HERE
Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
Log in to Surescripts
Log in to CoverMyMeds; For details on drug coverage click HERE;
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