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

This policy covers Aralast NP, Glassia, Prolastin‑C, and Zemaira (alpha1‑proteinase inhibitor [human]) for adults with clinically evident emphysema from severe congenital AAT deficiency (FDA‑approved) and for panniculitis due to AAT deficiency (compendial use), and does not support uses outside these indications. For emphysema approval the patient must be an adult nonsmoker with baseline AAT <11 micromol/L (<80 mg/dL) with documentation of diagnosis and smoking status; approvals are for 12 months with dosing 60 mg/kg IV once weekly.

"Chronic augmentation and maintenance therapy in adults with clinically evident emphysema due to severe congenital deficiency of alpha1-antitrypsin deficiency."

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