House Dust Mite Allergen Extract (Odactra)

SELF ADMINISTRATION

Indications for Prior Authorization:

  • Indicated for patients 18 to 65 years of age for the treatment of House Dust Mite (HDM)-induced allergic rhinitis with or without conjunctivitis

Patients must meet the following criteria for the indication(s) above:

  • Patient is 18 years of age or older, AND
  • Prescribed by or in consultation with an allergist, immunologist, or an otolaryngologist (ENT) physician specialist, AND
  • Diagnosis of house dust mite-induced allergic rhinitis confirmed by meeting one of the following conditions:
    • Patient has a positive skin test response to house dust mite allergen extracts, OR
    • Patient has a positive in vitro test (e.g. a blood test for allergen-specific IgE antibodies) for house dust mite, AND
  • Odactra will not be used with subcutaneous allergen immunotherapy (e.g. allergy shots) or sublingual allergen immunotherapy (e.g. Grastek, Oralair, Ragwitek), AND
  • Patient does not have severe, unstable or uncontrolled asthma; history of any severe systemic allergic reaction or any severe local reaction to sublingual allergen immunotherapy; history of eosinophilic esophagitis; or hypersensitivity to any inactive ingredients in Odactra 

Dosing:

  • 1 tablet sublingually daily
  • Administer first dose of Odactra under the supervision of a physician with experience in the diagnosis and treatment of allergic diseases. Observe patients in the office for at least 30 minutes following the initial dose

Approval:

  • 1 year