Colorado Rocky Mountain Health Plans SLIT Coverage | OpenPayer

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Colorado Rocky Mountain Health Plans SLIT Coverage | OpenPayer

Initial Therapy - Grastek

Covered when ALL of the following are met

Grastek initial authorization: (1) Diagnosis of grass pollen-induced allergic rhinitis; (2) Diagnosis confirmed by either a 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 to Timothy grass or cross-reactive grass pollens; (3) Treatment is started or will be started at least 12 weeks before the expected onset of the grass pollen seasonstart >= 12 weeks before season

Authorization issued for 12 months

Reauthorization - Grastek

Covered when ALL of the following are met

Grastek reauthorization: Documentation of positive clinical response to Grastek therapynone

Authorization issued for 12 months

Initial Therapy - Oralair

Covered when ALL of the following are met

Oralair initial authorization: (1) Diagnosis of grass pollen-induced allergic rhinitis; (2) Diagnosis confirmed by either a positive skin test to any of the five grass species in Oralair (Sweet Vernal, Orchard, Perennial Rye, Timothy, and Kentucky Blue) or cross-reactive grass pollens OR in vitro testing for pollen-specific IgE antibodies to any of the five grass species; (3) Treatment is started or will be started at least 4 months before the expected onset of the grass pollen seasonstart >= 4 months before season

Reauthorization - Oralair

Covered when ALL of the following are met

Oralair reauthorization: Documentation of positive clinical response to Oralair therapynone

Initial Therapy - Ragwitek

Covered when ALL of the following are met

Ragwitek initial authorization: (1) Diagnosis of short ragweed pollen-induced allergic rhinitis; (2) Diagnosis confirmed by either a positive skin test to short ragweed pollen OR in vitro testing for pollen-specific IgE antibodies to short ragweed pollen; (3) Treatment is started or will be started at least 12 weeks before the expected onset of the short ragweed pollen seasonstart >= 12 weeks before season

Authorization issued for 12 months

Reauthorization - Ragwitek

Covered when ALL of the following are met

Ragwitek reauthorization: Documentation of positive clinical response to Ragwitek therapynone

Authorization issued for 12 months

Initial Therapy - Odactra

Covered when ALL of the following are met

Odactra initial authorization: (1) Diagnosis of house dust mite (HDM)-induced allergic rhinitis; (2) Diagnosis confirmed by either a positive skin test to licensed house dust mite allergen extracts OR in vitro testing for IgE antibodies to Dermatophagoides farinae or Dermatophagoides pteronyssinus house dust mitesnone

Authorization issued for 12 months

Reauthorization - Odactra

Covered when ALL of the following are met

Odactra reauthorization: Documentation of positive clinical response to Odactra therapynone

Authorization issued for 12 months

Member coverage for sublingual immunotherapy is subject to the member's specific benefit plan, applicable state mandates, and any federal regulatory requirements. Other policies and utilization management programs may also affect coverage determinations, including prior authorization processes and supply limits. Providers should verify plan-level benefits and restrictions before initiating therapy to ensure services and supplies are covered under the member's plan.