Payer PolicyActive
Ecallantide (Kalbitor)
EVICORE-MEDICAL_DRUG-17A19E96
EviCore by Evernorth
Effective: May 1, 2020
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Covered: Ecallantide (Kalbitor) is covered only for the FDA‑approved use—treatment of acute hereditary angioedema (HAE) due to C1‑INH deficiency (Type I or II); non‑FDA uses are excluded. Key requirements: baseline labs showing functional C1‑INH <50% and low serum C4, prescribing by or consultation with an allergist/immunologist or HAE specialist, dosing limited to ≤30 mg subcutaneously no more than twice daily, reauthorization requires prior Kalbitor use with documented favorable clinical response, and approvals are for 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"Kalbitor is indicated for the treatment of acute Hereditary Angioedema (HAE) attacks."
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