Peanut Immunotherapy (CPB 0968, reviewed 2026-05-27)
Summary
Aetna considers oral Palforzia medically necessary to mitigate allergic reactions, including anaphylaxis, in members with a confirmed peanut allergy when specific criteria are met. The criteria cover confirmation of the diagnosis by serum IgE level or skin prick test, use with a peanut-avoidant diet, and exclusion of uncontrolled asthma, a history of eosinophilic esophagitis, or other eosinophilic gastrointestinal disease. Members must be 1 to 17 years of age for initial dose escalation, or 1 year of age or older for up-dosing or maintenance. Aetna considers all other indications experimental, investigational, or unproven, along with co-administration with a monoclonal antibody such as omalizumab and use for emergency treatment of allergic reactions.
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