Primary navigation

    Cinqair

    Drug - Cinqair® (reslizumab) [Teva]

    January 2018

    Therapeutic area - Asthma

    Initial approval criteria

    • Patient must be 18 years of age or older AND
    • Has a diagnosis of asthma with an eosinophilic phenotype indicated by blood eosinophil of ≥400 cells/mcL within 3 to 4 weeks of dosing (documentation of lab results must be submitted at time of request) AND
    • Must be used for add-on maintenance treatment in patients with 6 months of claims history showing adherence with BOTH of the following:
      • High-dose inhaled corticosteroids
      • An additional controller medication (e.g., long-acting beta agonist, etc.) AND
    • Has evidence of severe disease indicated by ALL of the following:
      • Asthmatic symptoms occurring throughout the day
      • Frequent nighttime awakenings of 7 times per week
      • Multiple doses of short-acting beta agonist (SABA) required daily for symptom control
      • Extreme limitation of normal activities due to asthma symptoms
      • Lung function (percent predicted FEV1) <60%
      • More frequent and intense asthma exacerbations requiring oral systemic corticosteroids relative to mild or moderate asthma AND
    • Has uncontrolled disease documented by ONE of the following:
      • At least one exacerbation in the previous year resulting in hospitalization or emergency department visits OR
      • Patient requires daily oral corticosteroids in addition to regular maintenance therapy AND
    • At time of request, provide baseline FEV1 and frequency of asthma exacerbation per month
    • Initial approval will be for 6 months in duration

    Renewal approval criteria

    • Absence of unacceptable toxicity from the drug. Examples of unacceptable toxicity include the following:
      • Parasitic (helminth) infection
      • Herpes zoster infection
      • Headache
      • Injection site reaction
      • Back pain
      • Fatigue
    • Treatment has resulted in clinical improvement as documented by at least ONE of the following:
      • Decreased frequency of exacerbations (defined as improvement of asthma as demonstrated by decreased use of oral/systemic corticosteroids and/or less frequent hospitalizations and/or reduced frequency of ER visits) OR
      • Improvement in lung function, measured in FEV1
    • Renewal approval will be for 12 months in duration

    Quantity limits:

    One infusion (3 mg/kg) per 28 days

    Denial criteria

    Concurrent use with Xolair or Nucala

    Billing of Cinqair

    Cinqair is not covered through the MHCP fee-for-service pharmacy benefit and must be submitted as a medical claim. Cinqair should be administered by a healthcare professional in a healthcare setting. In line with clinical practice, monitoring of patients after administration of biologic agents is recommended by the manufacturer.

    Questions?

    MHCP Provider Call Center 651-431-2700 or 800-366-5411

    back to top