- Alpha-1 Antitrypsin Deficiency:
Age Requirement: >= 18
Duration: 6 Month(s)
Specialist Required: Yes
Medical Test Required: Yes
Specialist Type(s): Pulmonologist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Required Evidence of Emphysema: Yes
Documented Serum AAT Level: N/A
Policy Required Patient Must be a Non-smoker: No
Documented Diagnosis: Yes
- Prior Authorization: Alpha-1 Antitrypsin Deficiency:
PA Applies
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