C1 Esterase Inhibitor (Ruconest)

Ruconest is covered only for treatment of acute hereditary angioedema (HAE) attacks due to C1‑INH deficiency (Type I or II) and is not covered for prophylaxis or other non‑FDA‑approved indications. Coverage requires baseline labs showing functional C1‑INH <50% and low serum C4, prescription/consultation by an allergist/immunologist or HAE specialist, adherence to dosing limits (≤50 IU/kg, max 4,200 IU, no more than twice daily), 12‑month authorization, and reauthorization contingent on prior Ruconest use with documented favorable clinical response.

"Implicit limitation (inferred from the policy content): use for prophylaxis or non-FDA-approved uses is not supported by the coverage criteria in this document (policy only addresses treatment of a..."

Sign up to see full coverage criteria, indications, and limitations.