Peanut allergy is one of the most common food allergies in the world, affecting more than 1.6 million children and teens in the United States alone.1,2 A first-of-its-kind treatment for patients with peanut allergy is now available. The U.S. Food and Drug Administration (FDA) announced approval of Palforzia®, by the manufacturer Aimmune Therapeutics, Inc., as of January 31, 2020. This new oral immunotherapy drug works to prevent or decrease chances of severe allergic attack upon accidental exposure to peanuts.
Treatment with Palforzia initiates in children ages 4-17. Treatment begins over the course of several months. Patients receive a gradual increase in dosage from 3 mg per day to a maintenance dose of 300 mg per day – about the same amount of protein as in one peanut. The first doses at each increasing level must take place in a health care facility, staffed and equipped to manage severe allergic reactions. A minimum of 12 office/health care facility visits are necessary to reach maintenance dosing. Individuals of 18 years or older can continue to take this drug if they initiated treatment at some point between the ages of 4-17.
Palforzia will be designated as not-covered on Cigna’s formularies initially, with medical necessity review available. Palforzia will be classified as a Specialty drug. Cigna will conduct a comprehensive review evaluating the clinical safety and efficacy, the medication’s overall value, and other factors before making a coverage decision.
Currently available treatments for peanut exposures include emergency administration of epinephrine. A second possible peanut immunotherapy, Viaskin® Peanut (DBV Technologies), a daily skin patch formulation intended for children age 4-11 years, has an FDA action date of August 5, 2020.
Health benefit plans vary, but in general to be eligible for coverage a drug must be approved by the Food and Drug Administration (FDA), prescribed by a health care professional, purchased from a licensed pharmacy and medically necessary. Some plans require use an in-network pharmacy for prescriptions to be covered. Coverage is subject to any plan deductible, copayment and/or coinsurance requirements. Product availability may vary by location and plan type and is subject to change. All group health insurance policies and health benefit plans contain exclusions and limitations. For costs and complete details of prescription drug coverage, contact a Cigna representative.
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