Icatibant (Firazyr)

Firazyr (icatibant) is covered only for treatment of acute hereditary angioedema (HAE) attacks in adults ≥18 years and is excluded for prophylaxis, combination use with other acute HAE agents, and any off‑label/compendial uses. Coverage requires documented HAE with low C4 and abnormal C1 inhibitor (antigenic and/or functional) testing, confirmation that the request is for an acute attack in a patient ≥18, and meeting the policy’s safety/coverage criteria.

"Request is for the treatment of acute attacks of HAE (i."

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