Depemokimab-ulaa (Exdensur) (CPB 1098, reviewed 2026-08-10)
Summary
Aetna considers depemokimab-ulaa (Exdensur) medically necessary for asthma in members 12 years of age or older under either of two sets of criteria. The first is a member who has previously received a biologic indicated for asthma in the past 12 months and will continue maintenance asthma treatment with the requested medication. The second is severe asthma with a baseline blood eosinophil count of at least 150 cells per microliter or dependence on oral systemic corticosteroids, uncontrolled asthma shown by two or more exacerbations requiring oral or injectable corticosteroids, one or more exacerbations resulting in hospitalization or emergency care, or poor symptom control in the past 12 months, and inadequate control despite high-dose inhaled corticosteroid and an additional controller at optimized doses. Continuation is medically necessary when asthma control has improved on the medication or the daily maintenance oral corticosteroid dose has been reduced or discontinued, and the member continues maintenance asthma treatment. Aetna considers all other indications experimental, investigational, or unproven. Members cannot use the medication with another biologic or targeted synthetic drug for the same indication. The medication must be prescribed by or in consultation with an allergist/immunologist or pulmonologist. This policy covers commercial medical plans.
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