Alpha-1 Proteinase Inhibitor (Aralast NP, Glassia, Prolastin-C, Zemaira)

Covers Aralast NP, Glassia, Prolastin‑C, and Zemaira for adults (≥18) with clinically evident emphysema from severe congenital AAT deficiency who are nonsmokers with baseline AAT <11 µmol/L, and for adult panniculitis due to AAT deficiency (compendial use); excludes patients <18, current smokers, those with pretreatment AAT ≥11 µmol/L, and uses outside FDA‑approved or compendial indications. Authorization is limited to 12 months and requires documentation of diagnosis, age, baseline AAT level, smoking status (for emphysema), and a prescription consistent with the recommended 60 mg/kg IV once‑weekly dosing and applicable safety criteria.

"Chronic augmentation and maintenance therapy in adults with clinically evident emphysema due to severe congenital deficiency of alpha-1-antitrypsin (AAT) deficiency (FDA‑approved indication)."

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