Aralast™ NP, Glassia™, Prolastin-C® , and Zemaira® (alpha1- proteinase inhibitor [human])

Covered: Aralast NP, Glassia, Prolastin‑C, and Zemaira are covered for augmentation/maintenance therapy of clinically evident emphysema due to severe hereditary alpha1‑antitrypsin (AAT) deficiency (FDA‑approved) and for compendial treatment of AAT‑deficiency panniculitis; other indications are not covered. Key requirements: patient ≥18 years, pretreatment AAT <11 µmol/L (or <80 mg/dL by radial immunodiffusion or <57 mg/dL by nephelometry), documented nonsmoker for emphysema, documentation of diagnosis, numeric AAT result with assay method, patient weight, recommended dosing 60 mg/kg IV weekly, and approvals issued for 12 months.

"Chronic augmentation and maintenance therapy in adults with clinically evident emphysema due to severe hereditary deficiency of alpha1-antitrypsin (AAT)."

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