Does Medicare Cover Fasenra? 

If you have asthma, you may experience symptoms like tightness in your chest, coughing, shortness of breath or wheezing. Although these conditions can be symptomatic of many ailments, the National Institutes of Health (NIH) explains a distinctive pattern for asthma. People with asthma may have symptoms that come and go over time, begin or worsen with a virus, or heighten in the morning or at nighttime. 

Eosinophilic asthma

There are different types of asthma. Allergic asthma may be linked to a family history of allergies and can be triggered by environmental substances like pollen, pet dander, dust and smoke. One subtype of asthma, eosinophilic asthma (EOS or e-asthma), is so named because of the increased number of eosinophils (white blood cells) found in the patient’s blood, lungs and mucus. Allergy-induced asthma usually begins in childhood. EOS asthma typically presents itself in middle age, and EOS asthma patients often don’t have allergic conditions.

Asthma treatments

Although there is no cure for asthma, there are ways to manage symptoms. Depending on your type of asthma and the symptom management plan you develop with your healthcare provider, you may use quick-relief inhalers, take oral medication or receive allergy shots. EOS asthma patients may require a different approach, such as targeted therapy.

Monoclonal antibody therapy, designed to reduce blood eosinophils, involves medication delivered by injection or intravenously. Patients must be at least 12 years old and have asthma uncontrolled by traditional asthma medication. Benralizumab, sold under the brand Fasenra, is one of the medications used in this type of treatment. Your healthcare provider will inject the drug under your skin with a prefilled syringe, or a patient or caregiver may administer the medication with the Fasenra pen.

Medicare drug coverage

Medicare Part D is prescription drug coverage you can get when you first enroll in Medicare or during Open Enrollment. Part D covers oral and self-administered prescription drugs you buy at a participating pharmacy. Some private companies offer stand-alone Prescription Drug Plans and/or Medicare Advantage plans that include drug coverage. These plans vary in price and availability. When you search a plan’s formulary or approved drug list, it’s a good idea to check the brand and generic names of the medication.

Medicare Part B offers limited drug coverage, excluding self-administered drugs. If your doctor administers a subcutaneous (under the skin) injection in the healthcare provider’s office, you may be eligible for coverage under the Part B drug benefit. If you use a Medicare-contracted healthcare provider, the procedure is medically necessary and you meet your Part B deductible, Medicare pays 80% of the Medicare-approved amount.  

Other Medicare coverage for asthma

Part B covers the cost of a nebulizer and specific medication used with the nebulizer. The benefit falls under durable medical equipment (DME), requiring a doctor’s prescription for medically necessary home use. The Part B deductible applies, and you cover 20% of the Medicare-approved charges.

To qualify for the benefit, use a Medicare-participating supplier. Providers participating with Medicare accept assignment, meaning they bill Medicare directly, accept Medicare payments, and bill you no more than your cost-sharing amount according to policy. If you have Medicare Advantage, check the provider directory to find Medicare-participating healthcare doctors and suppliers. Original Medicare members can identify participating providers through the government Medicare website.

Resources

Patient advocacy groups for people with EOS asthma include American Partnership for Eosinophilic Disorders (APFED) and the Allergy & Asthma Network (AAN). Since asthma is a chronic lung disease, the American Lung Association may also be a helpful resource.