Alpha 1-Proteinase Inhibitors

Aetna covers intravenous alpha1‑proteinase inhibitor therapy (eg, Prolastin‑C; Aralast NP, Glassia, Zemaira only if Prolastin‑C is contraindicated, not tolerated, or ineffective) for emphysema due to AAT deficiency when pretreatment serum AAT <11 μmol/L (≤80 mg/dL RID or ≤50 mg/dL nephelometry), post‑bronchodilator FEV1 25–80% predicted, and a documented homozygous PiZZ/PiZ(null)/Pi(null,null) or other genotype/phenotype associated with such low AAT (PiMZ and PiMS excluded). All other indications (including use without clinical emphysema, inhaled/PEGylated/recombinant forms, gene therapy, and listed inflammatory/autoimmune or organ‑injury uses) are experimental/investigational and not covered, and these products are contraindicated in IgA‑deficient patients with anti‑IgA antibodies.

"ICD‑10 codes listed as not covered for CPB indications (not all-inclusive): D80."