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Benralizumab (Fasenra®)
BCBS Tennessee·Allergy & Immunology, Pulmonology, Rheumatology +2 more·Medical Policy
Effective date
Dec 1, 2026
We identified it
Sep 10, 2026
Summary
This is a new medical policy for Benralizumab (Fasenra®) establishing coverage criteria, prior authorization requirements, and prescriber specialty restrictions for three FDA-approved indications: severe asthma (ages 6+), eosinophilic granulomatosis with polyangiitis/EGPA (ages 18+), and hypereosinophilic syndrome/HES (ages 12+). The policy requires specific eosinophil counts, prior medication trials, clinical documentation, and specialist prescribing. Do not implement until December 1, 2026.
Action Required
By November 15, 2026: Billing team must prepare to implement prior authorization requirements for Benralizumab (Fasenra®) claims effective December 1, 2026. (1) Update billing system to require prior auth submission before claims are processed for benralizumab. (2) Create documentation checklists for each indication (asthma, EGPA, HES) and distribute to providers and clinical staff—specify required items: baseline eosinophil counts, medication trial history, and relevant clinical evidence per indication. (3) Configure system to enforce prescriber specialty restrictions: asthma requires allergist/immunologist or pulmonologist; EGPA requires allergist/immunologist, pulmonologist, or rheumatologist; HES requires allergist/immunologist, hematologist, or cardiologist. (4) Set authorization periods: 6 months initial for asthma, 12 months for EGPA and HES; 12 months continuation for all. (5) Implement exclusion logic to deny HES claims for members with secondary causes or FIP1L1-PDGFRA kinase-positive status. (6) Flag all claims for verification that member is not concomitantly using other biologic or targeted synthetic drugs for the same indication. (7) Notify providers in writing of new requirements by November 1, 2026 with sample prior auth forms. Failure to obtain prior authorization before December 1, 2026 will result in claim denials.