For continuation of therapy , all of the following: o Documentation of a positive clinical response as demonstrated by at least one of the following: Reduction in the frequency of exacerbations Decreased utilization of rescue medications Increase in percent predicted FEV1 from pretreatment baseline Reduction in severity or frequency of asthma-related symptoms (e.g., wheezing, shortness of breath, coughing, etc.)和O与含ICS的维护药物结合使用; and o Patient is not receiving Tezspire in combination with any of the following: Anti-interleukin 5 therapy [e.g., Cinqair (reslizumab), Fasenra (benralizumab), Nucala (mepolizumab] Anti-IgE therapy [e.g., Xolair (omalizumab)] Anti-interleukin 4 therapy [e.g., Dupixent (dupilumab)]和o tezspire剂量是根据美国食品和药物批准的标签; o重新授权的标签将不超过12个月的代码,以下是仅提供参考目的的程序和/或诊断代码的列表在本策略中列出代码并不意味着代码所描述的服务是涵盖或未覆盖的健康服务。卫生服务的福利覆盖范围由成员特定的福利计划文件和可能需要特定服务覆盖的适用法律确定。纳入代码并不意味着要偿还或保证索赔付款的任何权利。其他政策和准则可能适用。
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