Methyltestosterone capsule — Point32Health
Hereditary angioedema (HAE)
Preferred products
- generic testosterone intramuscular injection (e.g., testosterone cypionate)
- generic testosterone topical gel or solution (e.g., testosterone 1% gel, testosterone 30 mg/actuation solution)
- methyltestosterone capsule (if requesting tablet form)
Initial criteria
- Diagnosis of hereditary angioedema (HAE) OR one of the specified conditions
- Patient age ≥ 18 years
- Documentation of inadequate response, intolerance, or contraindication to ALL of the following: a generic testosterone intramuscular injection (e.g., testosterone cypionate) AND a generic testosterone topical gel or solution (e.g., testosterone 1% gel, testosterone 30 mg/actuation solution)
- If the request is for methyltestosterone tablets, documentation of inadequate response, intolerance, or contraindication to methyltestosterone capsule