Medicare AdvantagePrior AuthHigh impact
Asthma Interleukin Inhibitors (Cinqair®, Nucala™, Fasenra®) (Revised)
Humana·Pulmonology, Allergy & Immunology, Internal Medicine +1 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana has revised prior authorization requirements for asthma interleukin inhibitors (Cinqair, Nucala, Fasenra) for Medicare Advantage plans, with specific eosinophil count thresholds and treatment failure criteria that must be met for approval. The policy covers multiple conditions including severe asthma, EGPA, HES, nasal polyposis, and COPD with eosinophilic phenotype.
Action Required
By January 1, 2026: Billing team must ensure prior authorization is obtained for all Cinqair, Nucala, and Fasenra prescriptions for Medicare Advantage patients. Providers must document specific eosinophil counts (≥150 cells/μL current or ≥300 cells/μL in past 12 months for asthma), treatment failure on maximum tolerated inhaled corticosteroids plus LABA, and diagnosis-specific criteria. Update encounter forms to include eosinophil count documentation requirements. Claims will be denied without proper prior authorization.