Hereditary Angioedema (HAE), Treatment and Prophylaxis – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Berinert, Ruconest, and Kalbitor for acute HAE attacks (not in combination with other approved acute HAE agents) when prescribed by an immunologist/allergist, and treats Cinryze as not medically necessary for HAE treatment under Medical Necessity Plans but allowable for routine prophylaxis under Non‑Medical Necessity Plans for patients ≥6 years (not combined with other prophylactics). Coverage requires diagnostic proof of HAE (low C1‑INH antigenic or functional level or specified pathogenic gene variants with refractory recurrent angioedema), for Berinert documentation of failure/contraindication/intolerance to Ruconest and for Berinert/Ruconest a physician attestation that the patient cannot self‑administer, with prescriber specialty specified, no concurrent HAE therapies, and initial/renewal authorizations limited to ≤12 months with reauthorization requiring documented clinical benefit.

"Treatment of an acute hereditary angioedema (HAE) attack with Berinert (C1 esterase inhibitor, human), Ruconest (C1 esterase inhibitor, recombinant), or Kalbitor (ecallantide) when: (a) used for tr..."