Payer PolicyActive
C1 Esterase Inhibitor (Berinert)
EVICORE-MEDICAL_DRUG-11C867BE
EviCore by Evernorth
Effective: May 1, 2020
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Berinert is covered for treatment of acute HAE attacks (FDA‑approved) and for prophylaxis as an off‑label compendial use in patients with HAE type I or II due to C1‑INH deficiency, with dosing limited to IV up to 20 IU/kg no more than once daily. Initial and reauthorization approvals (up to 12 months) require baseline labs showing functional C1‑INH <50% and low serum C4, prescription by or in consultation with an allergist/immunologist or HAE specialist, and reauthorization requires documentation of clinical benefit.
Coverage Criteria Preview
Key requirements from the full policy
"Berinert is indicated for the treatment of acute attacks of Hereditary Angioedema (HAE)."
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