Aetna's Clinical Policy Bulletin 0925 covers benralizumab (Fasenra) for commercial medical plans, and precertification is required for it in applicable plan designs. Aetna considers benralizumab medically necessary for severe asthma in members 6 years of age or older who meet the listed criteria, for eosinophilic granulomatosis with polyangiitis (EGPA) in members 18 years of age or older, and for hypereosinophilic syndrome (HES) in members 12 years of age or older. Aetna considers benralizumab experimental, investigational, or unproven for other conditions, including chronic obstructive pulmonary disease, acute bronchospasm, eosinophilic cystitis, eosinophilic pneumonia, eosinophilic annular erythema, laryngeal papillomatosis and status asthmaticus. Hypereosinophilic syndrome secondary to a non-hematologic cause and FIP1L1-PDGFRA kinase-positive HES are listed as exclusions.
Get alerts when payers change rules like this one
We check Aetna and other payers every day and email you when a change matches your specialty and state.
01Billing team: Get precertification before scheduling benralizumab (Fasenra) by calling (866) 752-7021 or faxing (888) 267-3277, and use the Statement of Medical Necessity forms under Specialty Pharmacy Precertification where needed.
02Billing team: For commercial plans, the Site of Care Utilization Management Policy applies to benralizumab, so check Utilization Management on Site of Care for Specialty Drug Infusions for site of service.
03Providers: Confirm the prescriber is one of the listed specialties for the indication: allergist/immunologist or pulmonologist for asthma; allergist/immunologist, pulmonologist or rheumatologist for EGPA; allergist/immunologist, hematologist or cardiologist for HES.
04Billing team: Bill HCPCS J0517 per 1 mg only when the selection criteria are met.
05Providers: Benralizumab cannot be used with any other biologic drug or targeted synthetic drug for the same indication, and current smokers or vapers should be counseled on the harmful effects of smoking and vaping on pulmonary conditions and on available cessation options.
Summaries are AI-assisted. Always confirm against the original payer notice.
What is PolicyChanges
One workspace for payer rules, prior auth, coding and compliance
Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.