Firazyr — Medica
acute hereditary angioedema (HAE) attacks in adults
Preferred products
- generic icatibant
- Sajazir
Initial criteria
- Patient meets the standard Hereditary Angioedema – Icatibant Prior Authorization Policy criteria
- Patient has tried one Preferred Product (generic icatibant or Sajazir) prior to approval of the Non-Preferred Product OR meets exception criteria
Approval duration
1 year