danazol — Blue Cross Blue Shield of Alabama
Long-term prophylaxis for HAE when first-line agents (C1-INH, lanadelumab, berotralstat) are not available or if oral therapy is required.
Initial criteria
- For HAE prophylaxis, patient must have a confirmed diagnosis of hereditary angioedema and be unsuitable for or have inadequate response/intolerance to first-line agents (C1-INH, lanadelumab, berotralstat).
- For myelofibrosis-associated anemia, patient must have serum erythropoietin ≥ 500 mU/mL and either no response or loss of response to erythropoietin-stimulating agent therapy.
Reauthorization criteria
- Continuation of therapy may be approved if the patient continues to experience clinical benefit and adverse effects are tolerable; use minimal effective dose.
Approval duration
12 months