Ruconest — Blue Cross Blue Shield of New Mexico

Initial criteria

• The requested quantity (dose) is within the program quantity limit (allows for 2 acute HAE attacks per month) OR
• The requested quantity (dose) exceeds the program quantity limit and there is support for therapy with a higher dose or quantity for the requested indication (e.g., frequency of attacks within the past 3 months has been greater than 2 attacks per month)

Approval duration

Initial: 6 months; Renewal: 12 months