omalizumab — Blue Cross Blue Shield of Montana
chronic rhinosinusitis with nasal polyps (CRSwNP)
Initial criteria
- Pretreatment IgE 30–1500 IU/mL AND weight 30–150 kg
- At least two symptoms: nasal discharge, nasal obstruction/congestion, loss/decreased smell, or facial pressure/pain
- Symptoms ≥12 consecutive weeks
- Diagnosis confirmed by anterior rhinoscopy/endoscopy or sinus CT
- Inadequate response to ≥4-week course of one intranasal corticosteroid (e.g., fluticasone, mometasone, Sinuva) OR intolerance/hypersensitivity/contraindication to intranasal corticosteroids
- Currently treated with and will continue standard nasal polyp maintenance therapy (nasal saline irrigation, intranasal corticosteroids)
- Requested dose based on pretreatment IgE and weight per FDA labeling and ≤600 mg every 2 weeks