Fasenra (benralizumab)

Authorization forms

Prefilled syringe (covered under medical benefit)

Traditional & Optimized (07/2020)

Medicare Part B (03/2019)

Autoinjector (covered under pharmacy benefit)

Traditional & Optimized (07/2020)

Priority Health no longer utilizes drug-specific prior authorization forms for most drugs covered under the pharmacy benefit.

Visit the Approved Drug List (ADL) to search by drug name and view the criteria and PA form.

Go to the ADL

For further information on medical drugs, please see the Injectable drugs page.