Odactra (Dermatophagoides farinae/Dermatophagoides pteronyssinus allergen extract) — United Healthcare
house dust mite (HDM)-induced allergic rhinitis
Initial criteria
- Diagnosis of house dust mite (HDM)-induced allergic rhinitis
- Diagnosis confirmed by ONE of the following: (a) Positive skin test to licensed house dust mite allergen extracts OR (b) in vitro testing for IgE antibodies to Dermatophagoides farinae or Dermatophagoides pteronyssinus house dust mites
Reauthorization criteria
- Documentation of positive clinical response to Odactra therapy
Approval duration
12 months