Health Net
Prolastin-C (alpha-1 proteinase inhib.(hum))
Drugs for the Lungs : Drugs for Asthma/COPD
  • Prior Authorization: Alpha-1 Antitrypsin Deficiency:
    PA Applies
  • 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