Does Medicare Cover Nucala? 

Asthma is a fairly common respiratory disorder that affects millions of children and adults across the United States. In fact, it’s estimated that nearly 10% of the population will experience asthma symptoms at some point in their lives. Although children are disproportionately affected by asthma, this condition can affect seniors as well. For many people, asthma is a lifelong illness that will require monitoring and treatment well into their retirement years.

Why asthma is a big deal for seniors

Seniors who experience asthma symptoms may be at a greater risk for severe medical complications. While asthma symptoms like shortness of breath and wheezing are troubling, a senior who has asthma may have a harder time battling symptoms due to the body’s natural tendency to weaken with age. Combine this with the greater potential for complications from other respiratory conditions like pneumonia, and you could be looking at life-threatening complications.

How is asthma treated?

Common asthma treatments include the use of nebulizers and prescription medications. Many children and seniors can also use rescue inhalers during times of an asthma attack. These inhalers are fast-acting, and the albuterol medications they deliver can relax smooth muscles in the lungs to open constricted airways. For more severe cases of asthma, prescription medications like Nucala (mepolizumab) may be needed instead.

What is Nucala?

Nucala is an asthma medication that targets white blood cells which cause lung inflammation. By reducing the number of white blood cells (eosinophils) in the body, it may be possible to experience a reduction in asthma symptoms and attacks. Unlike inhalers, Nucala is administered as an injection. In most cases, three injections are prescribed over the course of each month, but only your doctor can determine the injection and dosing schedule that is right for you.

How does Medicare cover Nucala?

Medicare coverage usually provides benefits for Nucala injections under Part B when it is administered by a medical provider in an outpatient setting. Medicare Part B requires a monthly premium, and you must also meet your plan’s deductible in order to receive Medicare coverage benefits for services.

In most cases, Medicare Part D does not cover injectable medications since these usually need to be administered by a healthcare professional in a clinical setting. If Nucala is prescribed to be administered at home, it may qualify for coverage under Medicare Part D. It would have to be included in your plan’s formulary. This is a list of prescription medications covered by your plan. It may be considered a specialty drug and costs can vary from plan to plan. 

If Nucala is administered while Medicare recipients are admitted to inpatient care facilities like a hospital or skilled nursing facility, Medicare Part A supplies coverage.