Kalbitor® (ecallantide)

EviCore covers Kalbitor (ecallantide) only for acute HAE attacks due to C1‑INH deficiency (HAE type I or II) when baseline functional C1‑INH is <50% of normal and serum C4 is low, and excludes non‑HAE angioedema and prophylactic/other uses. Coverage requires prescription by or consultation with an allergist/immunologist or HAE specialist, dosing limited to 30 mg subcutaneously with one possible repeat 30 mg within 24 hours, 12‑month authorization, documentation of diagnostic labs, prescriber specialty and dosing/treatment dates, and for reauthorization prior Kalbitor use with a documented favorable clinical response and compliance with applicable safety criteria.

"Kalbitor is indicated for the treatment of acute Hereditary Angioedema (HAE) attacks."

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