Anthem Blue Cross (HMO, PPO, EPO)
Firazyr (icatibant)
Drugs for the Heart : Drugs for the Heart
  • Hereditary Angioedema (HAE):
    Duration: 1 year(s)
    Documented Diagnosis: No
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    History of Moderate or Severe Attacks: No

  • Step Therapy: Hereditary Angioedema (HAE):
    ST Generic and Brand

  • Prior Authorization: Hereditary Angioedema (HAE):
    Duration: 1 year(s)

  • PA Applies
  • Available only through Specialty Pharmacy;
    For FAX form click HERE
    Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
     Log in to Surescripts
     Log in to CoverMyMeds; For details on drug coverage click  HERE;
  • Quantity Limit: 24 syringes per 30 day(s).
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