CINQAIR (reslizumab)

CINQAIR (reslizumab) 

OFFICE ADMININSTRATION

Indications for Prior Authorization: 

• Severe Eosinophilic Asthma

All of the following must be met as a condition(s) for coverage:

• Must be prescribed AND followed by a pulmonologist or immunologist, AND
• Patient must be at least 18 years of age, AND
• Eosinophil blood count of ≥ 150 cells µL within last 6 weeks or ≥ 300 cells/µL within the last 12 months, AND 
• Patient had inadequate response to a high-dose inhaled corticosteroid in combination with long-acting beta agonist [LABA] and has been compliant with therapy for at least 3 months, AND
• Patient meets one of the following within the past year:
  • One or more acute asthma-related ED visit(s)
  • One or more acute inpatient visits where asthma was the principle diagnosis
  • Use of chronic systemic steroids due to severe asthma OR two or more acute asthma exacerbations requiring oral systemic steroids AND
• Will not be used in combination with Xolair (omalizumab), or Nucala (mepolizumab), AND
• Patient is not a current smoker

Patients for whom therapy with reslizumab is not indicated include:

• Combination use with Omalizumab (Xolair) or Nucala (mepolizumab)
• Monotherapy use
• Patients with Chronic Obstructive Pulmonary Disease (COPD)
• Treatment of other eosinophilic conditions
• Relief of acute bronchospasm or status asthmaticus

Dosing:

Adult

• IV infusion: 3 mg/kg every 4 weeks by IV infusion over 20-50 minutes (asminister in healthcare setting by a healthcare professional prepared to manage anaphylaxis)

Younger than 18 years

• Safety and efficacy have not been established

Approval:

• Initially for 24 weeks (6 months)
• Re-Authorization consideration for 1 year (after initial 24 weeks) of therapy if the following criteria are met
  • Prescribed by a pulmonologist or immunologist, AND
  • Patient is continually compliant with all asthma medications, AND
  • Response to treatment with reslizumab (Cinqair), as evidenced by at least one of the following [must be documented in the medical record]:
    • Reduction in asthma symptoms (e.g., decreased number of sick days, improvement in physical activity, reduction in "as needed" use of short acting beta agonists), OR
    • Reduction in dose and frequency of inhaled steroids compared to baseline, OR
    • Reduction in acute asthma exacerbations requiring oral systemic steroids
• Subsequent re-Authorization consideration - yearly if all of the following criteria are met
  • Prescribed by a pulmonologist or immunologist, AND
  • Patient is continually compliant with all asthma medications, AND
  • Continued response to treatment with reslizumab (Cinqair), as documented by at least one of the following [must be documented in the medical record]:
    • Stable or reduced asthma symptoms (e.g., no increase in number of sick days, decrease in physical activity, increase in "as needed" use of short acting beta agonists), OR
    • Stable or reduced (but not discontinued) dose and frequency of inhaled steroids compared to baseline, OR
    • Stable or reduced asthma exacerbations requiring oral systemic steroids