Grastek — Medical Mutual
Allergen-induced allergic rhinitis with or without conjunctivitis due to timothy grass or cross-reactive grass pollens
Initial criteria
- Diagnosis confirmed by positive skin test OR in vitro testing for pollen-specific IgE antibodies to timothy grass or cross-reactive pollens
- Age ≥ 5 years AND age < 65 years
- Treatment will be initiated approximately 3 months before the start of grass pollen season AND continued throughout the season
- Medication is prescribed by or in consultation with an allergist, immunologist, or otolaryngologist (ENT) physician specialist
- Patient has tried and failed nasal or oral antihistamines AND nasal or oral corticosteroids
- First dose will be given under the supervision of a physician with experience in diagnosing and treating severe allergic reactions
- Epinephrine rescue auto-injection is available to patient at home
- None of the following are present: severe, unstable, or uncontrolled asthma; history of any severe systemic or severe local reaction to sublingual allergen immunotherapy; history of eosinophilic esophagitis
Reauthorization criteria
- Response to therapy is required for continuation of therapy
Approval duration
1 year