IL-4 inhibitors — Blue Cross Blue Shield of Texas

Initial criteria

• Prescriber has reduced the dose or discontinued any medications known to cause or worsen urticaria (e.g., NSAIDs) OR there is support that a reduced dose or discontinuation of any medication(s) known to cause or worsen urticaria is NOT appropriate
• Patient has ONE of the following: (A) Tried and had inadequate response to the FDA labeled maximum dose of ONE second-generation H-1 antihistamine (e.g., cetirizine, levocetirizine, fexofenadine, loratadine, desloratadine) after at least a 2-week duration of therapy AND ONE of the following: (1) Tried and had inadequate response to a dose titrated up to 4 times the FDA labeled maximum dose of ONE second-generation H-1 antihistamine OR (2) Support that patient cannot be treated with a dose titrated up to 4 times the FDA labeled maximum dose of a second-generation H-1 antihistamine; OR (B) Has an intolerance or hypersensitivity to ONE second-generation H-1 antihistamine; OR (C) Has an FDA labeled contraindication to ALL second-generation H-1 antihistamines

Approval duration

12 months