Oralair (Sweet Vernal, Orchard, Perennial Rye, Timothy, and Kentucky Blue Grass Mixed Pollens allergen extract) — United Healthcare

Initial criteria

• Diagnosis of grass pollen-induced allergic rhinitis
• Diagnosis confirmed by ONE of the following: (a) Positive skin test to any of the five grass species (Sweet Vernal, Orchard, Perennial Rye, Timothy, and Kentucky Blue grass mixed pollens) or cross-reactive grass pollens (e.g., Cocksfoot, Meadow Fescue, or Redtop) OR (b) in vitro testing for pollen-specific IgE antibodies to any of the five grass species or cross-reactive grass pollens
• Treatment is started or will be started at least 4 months before the expected onset of the grass pollen season

Reauthorization criteria

• Documentation of positive clinical response to Oralair therapy

Approval duration

12 months