Ruconest® (recombinant C1 esterase inhibitor)

Covered only for acute HAE attacks due to C1‑INH deficiency (type I or II); prophylactic or other uses are excluded. Coverage requires baseline labs showing functional C1‑INH <50% and low serum C4, prescription by or in consultation with an allergist/immunologist or HAE specialist, weight‑based dosing (50 U/kg if <84 kg; 4200 U if ≥84 kg) with a per‑dose cap of 4200 U and no more than two doses in 24 hours, 12‑month authorizations, and documentation of diagnosis, labs, weight, administration records and—for reauthorization—prior Ruconest use with objective favorable clinical response.

"Treatment of acute attacks of Hereditary Angioedema (HAE) (FDA-approved indication)."

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