Xolair — Medica

Initial criteria

• Patient is ≥ 12 years of age
• Patient has/had urticaria for > 6 weeks with symptoms > 3 days per week despite daily non-sedating H1 antihistamine therapy titrated up to four times the standard dose
• Medication prescribed by or in consultation with an allergist, immunologist, or dermatologist

Reauthorization criteria

• Patient has already received at least 6 months of therapy with Xolair
• Patient has experienced a beneficial clinical response defined by ONE of the following: decreased itch severity; OR decreased number or size of hives

Approval duration

initial 6 months; reauthorization 1 year