J7645 Insurance Policy Changes

Reslizumab (Cinqair) (CPB 0907, reviewed 2026-08-10)

Aetna updated its reslizumab (Cinqair) coverage policy for severe asthma treatment, effective immediately. The policy requires precertification for all commercial plans, restricts prescribing to allergists/immunologists or pulmonologists, and mandates specific clinical criteria including baseline eosinophil counts ≥400 cells/mcL or oral corticosteroid dependence, plus documented uncontrolled asthma despite high-dose ICS and additional controller therapy. Billing teams must implement prior authorization workflows and ensure claims include appropriate documentation before submission.