Firazyr — Cigna
acute hereditary angioedema (HAE) attacks in adults (age ≥ 18 years)
Preferred products
- generic icatibant
- Sajazir
Initial criteria
- Patient meets the standard Hereditary Angioedema – Icatibant Prior Authorization Policy criteria; AND
- Patient has tried one of generic icatibant or Sajazir [documentation required]; AND
- Patient cannot continue to use the Preferred medication due to a formulation difference in the inactive ingredient(s) (e.g., differences in stabilizing agent, buffering agent, and/or surfactant) which, per the prescriber, would result in a significant allergy or serious adverse reaction [documentation required]
Approval duration
1 year