Fasenra (benralizumab) prior authorization denied appeal
Anti-IL-5Rα for eosinophilic asthma, EGPA, HES
Typical PA criteria
- Severe asthma with eosinophil count ≥300/µL (or ≥150/µL on OCS)
- ICS/LABA optimization
- Age ≥6 (asthma) or per label
- Pulmonology or allergy prescriber
Why your PA was denied
- Eosinophil count below threshold
- ICS/LABA optimization not documented
- Non-specialist prescriber
- OCS dependence not documented
Evidence that overturns the denial
- ✓Peripheral eosinophil count within past 12 months
- ✓ICS/LABA regimen and adherence
- ✓OCS burst history with dates
- ✓ACT or exacerbation frequency
Q8W dosing after loading is a differentiator vs. Nucala; document any prior anti-IL-5 trials.
Free analysis identifies the cited policy and missing evidence. Then a finished letter that maps your chart to the criteria.
FAQ
Why was my Fasenra (benralizumab) prior authorization denied?+
The most common reasons are: Eosinophil count below threshold; ICS/LABA optimization not documented; Non-specialist prescriber. Your denial letter names the specific criteria you did not meet.
How do I appeal a Fasenra (benralizumab) denial?+
File a written appeal within 180 days that cites the insurer's clinical policy, includes a letter of medical necessity from the prescriber, and documents the criteria the insurer requires.
What evidence overturns a Fasenra (benralizumab) denial?+
Peripheral eosinophil count within past 12 months; ICS/LABA regimen and adherence; OCS burst history with dates.
What if the plan excludes Fasenra (benralizumab) entirely?+
Plan exclusions are different from medical-necessity denials. Check the Summary Plan Description. If the drug is fully excluded, an appeal will not overturn it; you may need a formulary exception or manufacturer assistance program.
Other drugs
- Wegovy (semaglutide)
- Zepbound (tirzepatide)
- Ozempic (semaglutide)
- Mounjaro (tirzepatide)
- Saxenda (liraglutide)