Oralair — Medical Mutual

Initial criteria

• Diagnosis confirmed by positive skin test OR in vitro testing for grass pollen-specific IgE antibodies to sweet vernal, orchard, perennial rye, timothy, or Kentucky blue grasses
• Age ≥ 5 years AND age < 65 years
• Treatment will be initiated approximately 4 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