Peanut Immunotherapy (CPB 0968, reviewed 2026-08-21)
Summary
Aetna considers oral Palforzia (peanut allergen powder-dnfp) medically necessary to mitigate allergic reactions, including anaphylaxis, in members with a confirmed peanut allergy when all initial approval criteria are met, including use with a peanut-avoidant diet, no uncontrolled asthma, no history of eosinophilic esophagitis or other eosinophilic gastrointestinal disease, and age 1 to 17 years for initial dose escalation or age 1 year and older for up-dosing or maintenance. Co-administration of Palforzia with a monoclonal antibody such as omalizumab, and Palforzia for the emergency treatment of allergic reactions, are considered experimental, investigational, or unproven, as are all other indications. The policy also states that the Initial Dose Escalation and the first dose of each Up-Dosing level must be given in a healthcare setting equipped to monitor members and manage anaphylaxis.
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