Are you one out of 25.7 million Americans living with asthma? If so, you may also be one of the 15 percent of those who has a severe type of the disease. Eosinophilic asthma affects 5 percent of adults living with severe case of asthma.
People with abnormally high levels of a certain type of white blood cells called eosinophils may experience eosinophilic asthma. This type of asthma does not respond well to standard treatments, so many doctors prescribe add-on medications like Nucala to help control it and to reduce its symptoms.
If your physician has recommended Nucala for you because you have eosinophilic asthma or Eosinophilic Granulomatosis with Polyangiitis (EGPA), you need to have all the facts about the medication, how it can help you, and whether your Medicare benefits cover the cost of Nucala.
What is Nucala?
Nucala, also known as mepolizumab, is an add-on medication used for maintenance treatment of eosinophilic asthma. It is a humanized, interleukin-5 antagonist monoclonal antibody that works by targeting and controlling the white blood cells called eosinophils. High levels of eosinophils cause severe inflammation in the body and trigger eosinophilic asthma attacks.
When your doctor injects Nucala subcutaneously once every four weeks, the level of eosinophil cells decreases. This, in turn, decreases airway inflammation and may reduce severe asthma attacks.
For people with eosinophilic asthma or EGPA, Nucala may improve, control, and reduce symptoms of the condition. Research has shown that if you use Nucala along with your other medications, you could reduce the incidence of severe attacks by up to 50 percent. Nucala is a non-steroid medication which means that using it in addition to your other medications does not increase your steroid intake.
Medicare Coverage for Nucala
If you have Original Medicare Part B (Medical Insurance), you have coverage for a limited number of prescription drugs under certain circumstances. Your Medicare coverage (Part B) includes some injectable drugs that are administered by a licensed medical provider who accepts assignment. It does not cover self-administered drugs.
With Medicare benefits you pay 20 percent of the approved amount and Medicare pays 80 percent. You must also pay the deductible for Medicare Part B which is $185.00 in 2019.
In order to be eligible for Medicare coverage of Nucala cannot be used in combination with other monoclonal antibodies. Nucala can only be prescribed for patients over the age of 12. The patient must be diagnosed with asthma with eosinophilic phenotype at specific levels that your physician has examined and confirmed. It must be used as an add-on maintenance treatment with specific stipulations prescribed by your doctor. You must have one of the following indications: more than two exacerbations in previous year, or you require daily oral corticosteroids.
For treatment of Eosinophilic Granulomatosis with Polyangiitis (EGPA):
- You must be older than 18 years of age.
- You must have a confirmed diagnosis of EGPA.
- You must have a certain level of blood eosinophils that your physician has
examined and confirmed.
- You have had therapy of concomitant oral corticosteroids for over 4 weeks.
Depending on your location in the U.S., the out-of-pocket cost of Nucala ranges between $7,800.00 and $12,000.00 per year. With Medicare benefits included in Part B, 80 percent of the cost may be covered.
If you have purchased a Medigap policy to supplement your out-of-pocket costs through Original Medicare, you may have help paying for deductibles, coinsurance, or copayments. If you have enrolled in a Medicare Advantage plan, check your plan benefits to find out your exact cost for Nucala.