Ryplazim® (Plasminogen, Human-Tvmh) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Ryplazim only for plasminogen deficiency type 1 (hypoplasminogenemia) and considers it unproven/not medically necessary for idiopathic pulmonary fibrosis. Coverage requires plasminogen activity ≤45%, documented clinical signs/symptoms, prescription or consultation by a hematologist, dosing per FDA labeling, appropriate lab/clinical documentation (for continuation: prior Ryplazim use and objective improvement or ≥10 percentage‑point increase in plasminogen trough), and authorizations are limited to ≤12 months.

"Treatment of plasminogen deficiency type 1 (hypoplasminogenemia) when the following criteria are met:"

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