Grastek — United Healthcare

moderate to severe grass pollen-induced allergic rhinitis

Initial criteria

Diagnosis of moderate to severe grass pollen-induced allergic rhinitis defined by symptoms severe enough to interfere with quality of life (e.g., sleep disturbances; impairment of daily, sport, or leisure activities; impairment of school or work performance)
Diagnosis confirmed by one of the following: Positive skin test to Timothy grass or cross-reactive grass pollens (e.g., Sweet Vernal, Orchard/Cocksfoot, Perennial Rye, Kentucky blue/June grass, Meadow Fescue, or Redtop) OR in vitro testing for pollen-specific IgE antibodies for Timothy grass or cross-reactive grass pollens (e.g., Sweet Vernal, Orchard/Cocksfoot, Perennial Rye, Kentucky blue/June grass, Meadow Fescue, or Redtop)
Treatment is started or will be started at least 12 weeks before the beginning of the grass pollen season
History of failure, contraindication, or intolerance to two of the following: oral antihistamine [e.g., cetirizine (Zyrtec)] AND/OR intranasal antihistamine [e.g., azelastine (Astelin)] AND/OR intranasal corticosteroid [e.g., fluticasone (Flonase)] AND/OR leukotriene inhibitor [e.g., montelukast (Singulair)]
Not received in combination with similar cross-reactive grass pollen immunotherapy (e.g., Oralair)
Patient does not have unstable and/or uncontrolled asthma
Prescribed by or in consultation with a specialist in allergy and immunology

12 months