- ST_APPLIES
- Hereditary Angioedema (HAE):
Age Requirement: >= 12
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): 1 of Allergist;Immunologist;Rheumatologist
Reauthorization Required: No
Duration of Reauthorization: N/A
Diagnosis Type(s): Treatment of Acute HAE Attacks
HAE Type: Unspecified
History of Moderate or Severe Attacks: No
- Quantity Limit: 1 tablet per 1 day(s).
- Prior Authorization: Growth Hormone Deficiency:
Documented Diagnosis: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
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