Icatibant (Firazyr)

Icatibant (Firazyr) is covered only for acute HAE attacks due to C1‑INH deficiency (Type I or II) and is not covered for other HAE types without meeting these diagnostic criteria. Coverage requires baseline labs showing functional C1‑INH <50% and low serum C4, prescription by or consultation with an allergist/immunologist or HAE specialist, dosing limited to 30 mg SC up to three times daily, 12‑month approvals, and reauthorization requires prior icatibant use with physician‑documented favorable clinical response.

"Treatment of acute attacks of hereditary angioedema (HAE)."

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