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Ruconest (C1 esterase inhibitor, recomb)
Drugs for the Blood : Drugs for the Blood
  • Step Therapy: Hereditary Angioedema (HAE):
    ST Single Generic

  • Hereditary Angioedema (HAE):
    Age Requirement: >= 13
    Duration: 1 plan year
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): 1 of Allergist;Hematologist;Immunologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 plan year
    Diagnosis Type(s): 2 of Hereditary Angioedema;Treatment of Acute HAE Attacks
    HAE Type: Unspecified
    Documented Lab Values: 2 of Low C1-INH Antigenic Level;Low C1-INH Functional Level;Low C4 Level;Normal C1-INH level;Normal C4 level
    History of Moderate or Severe Attacks: Yes

  • Prior Authorization: Hereditary Angioedema (HAE):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 13
    Duration: 1 plan year
    Reauthorization Required: Yes

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