Haegarda (C1 esterase inhibitor, human) — United Healthcare

Routine prophylaxis to prevent hereditary angioedema (HAE) attacks

Preferred products

Diagnosis of hereditary angioedema (HAE) confirmed by one of the following:
C1 inhibitor (C1-INH) deficiency or dysfunction (Type I or II HAE) documented by one of the following per laboratory standard: C1-INH antigenic level below the lower limit of normal OR C1-INH functional level below the lower limit of normal
OR HAE with normal C1 inhibitor levels and one of the following: Confirmed presence of variant(s) in the gene(s) for factor XII, angiopoietin-1, plasminogen-1, kininogen-1, myoferlin, or heparan sulfate-glucosamine 3-O-sulfotransferase 6; OR recurring angioedema attacks refractory to high-dose antihistamines with confirmed family history of angioedema; OR recurring angioedema attacks refractory to high-dose antihistamines with unknown background de-novo mutation(s) (HAE-unknown)
Prescribed for the prophylaxis of HAE attacks
Not used in combination with other products indicated for prophylaxis against HAE attacks (e.g., Cinryze, Orladeyo, Takhzyro)
Prescriber attests that patient has experienced attacks of severity and/or frequency such that prophylactic therapy with Haegarda is clinically beneficial
Prescribed by an Immunologist OR Allergist
Patient age ≥ 6 years

Documentation of positive clinical response to Haegarda therapy
Reduction in utilization of on-demand therapies used for acute attacks (e.g., Berinert, Firazyr, Ruconest) as determined by claims information, while on Haegarda therapy
Prescribed for the prophylaxis of HAE attacks
Not used in combination with other products indicated for prophylaxis against HAE attacks (e.g., Cinryze, Orladeyo, Takhzyro)
Prescribed by an Immunologist OR Allergist

12 months