Fasenra (benralizumab) Letter of Medical Necessity
Fasenra (benralizumab) PA decisions often hinge on eosinophil count, prior biologic trials, and exacerbation history.
FDA-Approved Indications
- ● severe eosinophilic asthma
Why Fasenra Prior Authorization Gets Denied
The most common denial reasons across major payers:
- 1. Eosinophil count missing
- 2. Step therapy through Nucala
- 3. Exacerbation history insufficient
What to Include in a Fasenra Letter of Medical Necessity
Document blood eosinophil count, prior controller therapy, exacerbation history, prior biologic trials, and FEV1.
Key clinical evidence to cite:
- ✓ SIROCCO, CALIMA, ZONDA trials
Relevant guidelines:
- 📖 GINA Asthma Strategy
Fasenra Prior Authorization Criteria
Standard criteria across major US payers for Fasenra. Specific criteria vary by plan — RxCheckUp tailors each LMN to your patient's exact payer policy.
Typical step therapy requirements:
- → Step therapy through Nucala
Required documentation:
- ✓ ICD-10 diagnosis code with specificity
- ✓ Prior therapy history with dates, doses, and discontinuation reasons
- ✓ Specialist evaluation (where applicable)
- ✓ Baseline disease activity or biomarker results
- ✓ Clinical rationale citing FDA labeling or guidelines
Approval details:
Initial approval: typically 6 months. Renewal: 12 months with documented clinical response.
Payers Covering Fasenra
RxCheckUp tailors each LMN to the specific payer's medical policy and step therapy requirements:
Fasenra Prior Authorization FAQ
Why was my Fasenra prior authorization denied?
The most common denial reasons for Fasenra are: Eosinophil count missing; Step therapy through Nucala; Exacerbation history insufficient.
What should a Fasenra Letter of Medical Necessity include?
Document blood eosinophil count, prior controller therapy, exacerbation history, prior biologic trials, and FEV1.
Which payers cover Fasenra?
Fasenra is covered by major US payers including UnitedHealthcare, Aetna, Cigna, BCBS, though formulary tier and prior authorization criteria vary.