C1 Esterase Inhibitor (Cinryze)

Cinryze is covered only for routine prophylaxis of hereditary angioedema (HAE) in adolescents and adults per the FDA indication and is not covered for acute treatment, off‑label compendial uses, or in patients with life‑threatening hypersensitivity to C1 esterase inhibitors. Coverage requires documented HAE with C4 and C1 inhibitor lab confirmation (low C4 and low C1 inhibitor antigenic and/or functional levels), documentation that the request is for routine prophylaxis, no prior anaphylaxis to C1 esterase inhibitors, and consideration/monitoring of thromboembolic risk factors.

"Cinryze is indicated for routine prophylaxis against angioedema attacks in adolescent and adult patients with Hereditary Angioedema (HAE)."

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