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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.


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

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