Payer PolicyActive
Kalbitor (ecallantide)
EVICORE-MEDICAL_DRUG-4647252B
EviCore by Evernorth
Effective: February 1, 2024
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Kalbitor (ecallantide) is covered only for acute HAE attacks in patients with HAE type I or II (excluded for prophylaxis or non‑HAE indications). Coverage requires baseline functional C1‑INH <50% and low serum C4, prescription by or in consultation with an HAE specialist (allergist/immunologist), dosing 30 mg SC with one additional 30 mg allowed within 24 hours, 12‑month approval periods, and reauthorization requires prior Kalbitor use with documented favorable clinical response.
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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