Sublingual Immunotherapy as a Technique of Allergen-Specific Therapy

This policy covers sublingual allergen‑specific immunotherapy using FDA‑approved SLIT tablets (Oralair®, Grastek®, Ragwitek®) and the HDM product Odactra® for treatment of pollen‑ and house dust mite–induced allergic rhinitis/rhinoconjunctivitis. Coverage is limited to FDA‑labeled use (tablets ages 5–65, Odactra 12–65), requires documented positive species‑specific skin or IgE testing and inadequate control with pharmacotherapy/avoidance, mandates first‑dose physician supervision and prescription/training for an epinephrine autoinjector due to risk of severe allergic reactions, and excludes use in severe/uncontrolled asthma, prior severe SLIT reactions or eosinophilic esophagitis; other uses are considered experimental and subject to member benefit/state rules.

"Therapy is covered when proven effective for the relevant diagnosis based on peer-reviewed scientific literature and accepted standards of medical practice."