Ragwitek — United Healthcare

Initial criteria

• Diagnosis of moderate to severe short ragweed 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 short ragweed pollen OR in vitro testing for pollen-specific IgE antibodies for short ragweed pollen
• Treatment is started or will be started at least 12 weeks before the beginning of the short ragweed 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)]
• Patient does not have unstable and/or uncontrolled asthma
• Prescribed by or in consultation with a specialist in allergy and immunology

Reauthorization criteria

• Documentation of positive clinical response to Ragwitek therapy

Approval duration

12 months