- Quantity Limit: limit maximum 0.30 EA PER 1 day(s)
- Quantity Limit: limit maximum 2 EA PER 1 day(s)
- Quantity Limit: limit maximum 30 EA PER 30 day(s)
- May be covered under Medical Benefit.
- 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
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