XHANCE (fluticasone propionate nasal spray) — CareFirst (Caremark)

Initial criteria

• The patient is an adult (age ≥ 18 years)
• ONE of the following: patient has experienced an inadequate treatment response to an alternative intranasal corticosteroid therapy OR patient has experienced an intolerance to an alternative intranasal corticosteroid therapy OR patient is not a candidate for a trial with an alternative intranasal corticosteroid therapy

Reauthorization criteria

• The patient has achieved or maintained a positive clinical response to the requested drug (e.g., improvement in nasal congestion, mucopurulent drainage, facial pain/pressure/fullness, sense of smell, or improvement in polyp grade)

Approval duration

12 months