Payer PolicyActive
Ecallantide (Kalbitor)
EVICORE-MEDICAL_DRUG-DCABDDE5
EviCore by Evernorth
Effective: June 1, 2019
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Ecallantide (Kalbitor) is covered only for acute hereditary angioedema attacks due to C1‑INH deficiency (Type I or II) and is not covered for HAE with normal C1‑INH, other non–C1‑INH angioedema, or off‑label uses. Coverage requires baseline labs showing functional C1‑INH <50% and low C4, prescription/consultation by an allergist/immunologist or HAE specialist, dosing limited to 30 mg SC per dose (no more than three doses/24 hr), documentation of clinical benefit for continuation, and approval is for 12 months.
Coverage Criteria Preview
Key requirements from the full policy
"Kalbitor is indicated for treatment of acute Hereditary Angioedema (HAE) attacks."
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