Xolair — Medica

Initial criteria

• Patient is ≥ 18 years of age
• Diagnosis of chronic rhinosinusitis with nasal polyps as evidenced by direct examination, endoscopy, or sinus CT scan
• Patient experienced two or more of the following symptoms for at least 6 months: nasal congestion, nasal obstruction, nasal discharge, and/or reduction/loss of smell
• Baseline IgE level ≥ 30 IU/mL
• Patient has received at least 4 weeks of therapy with an intranasal corticosteroid AND will continue it concomitantly with Xolair
• Patient meets ONE of the following: (a) received at least one course of systemic corticosteroids for ≥5 days within the previous 2 years; OR (b) has contraindication to systemic corticosteroids; OR (c) has had prior surgery for nasal polyps
• Medication prescribed by or in consultation with an allergist, immunologist, or otolaryngologist

Reauthorization criteria

• Patient has already received at least 6 months of Xolair therapy
• Patient continues to receive therapy with an intranasal corticosteroid
• Patient has responded to Xolair therapy (e.g., reduced nasal polyp size, improved nasal congestion or sense of smell, reduced sinus opacification, decreased sino-nasal symptoms)

Approval duration

initial 6 months; reauthorization 1 year