UnitedHealthcare
Haegarda (C1 esterase inhibitor)
Drugs for the Blood : Drugs for the Blood
  • Prior Authorization: Hereditary Angioedema (HAE):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes

  • Hereditary Angioedema (HAE):
    Duration: 12 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): 1 of Allergist;Immunologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Diagnosis Type(s): Prophylaxis against Acute HAE Attacks
    HAE Type: 1 of HAE I;HAE II
    Documented Lab Values: 1 of Low C1-INH Antigenic Level;Low C1-INH Functional Level
    History of Moderate or Severe Attacks: No

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