Payer PolicyActive
Kalbitor (ecallantide)
EVICORE-MEDICAL_DRUG-D6A55BAD
EviCore by Evernorth
Effective: December 1, 2024
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Covered: Kalbitor (ecallantide) is covered only for acute hereditary angioedema (HAE) attacks due to C1‑INH deficiency (HAE type I/II); use for other indications is not supported. Key requirements: baseline labs showing functional C1‑INH <50% and low serum C4, prescription by or consultation with an HAE/allergy specialist, dosing per label (30 mg SC with one additional 30 mg within 24 hours if needed), documentation of labs/prescriber and dosing, reauthorization requires prior Kalbitor benefit, and approvals are for 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"FDA-approved Indication: Kalbitor is indicated for the treatment of acute Hereditary Angioedema (HAE) attacks."
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