Cinryze (C1 esterase inhibitor [human])
EVICORE-MEDICAL_DRUG-6623B109
Cinryze is covered only for prophylaxis of HAE attacks (FDA‑approved) and for treatment of acute HAE attacks (compendial off‑label) in HAE type I or II due to C1‑INH deficiency (other causes of angioedema excluded). Coverage requires baseline labs showing functional C1‑INH <50% of normal and low serum C4, prescription by or consultation with an allergist/immunologist or HAE specialist, dosing within age/weight limits per guidance, 12‑month approvals, and reauthorization with documented clinical benefit (reduced attack frequency/severity/duration or rapid symptom relief).
"Prophylaxis against Hereditary Angioedema (HAE) attacks (FDA-approved indication)."
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