- Granulomatosis with Polyangiitis:
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Rheumatologist
Reauthorization Required: No
Duration of Reauthorization: N/A
Microscopic Polyangiitis (MPA):
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: No
Medical Test Required: No
Specialist Type(s): Rheumatologist
Reauthorization Required: No
Duration of Reauthorization: N/A
- 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
- Step Therapy: ST_APPLIES
|