UTILIZATION MANAGEMENT MEDICAL POLICY
Defines prior authorization and medical necessity criteria for medical-benefit coverage of icatibant (subcutaneous injection) for treatment of acute HAE attacks in adults, including initial and continuation criteria, dosing limits, and exclusions (prophylaxis and non-listed indications).
Added that a person who previously met initial therapy criteria under the Coverage Review Department and has treated previous HAE attacks with icatibant is only required to meet continuation criteria; if prior Coverage Review Department criteria were not met, initial criteria must be met.
Deleted '[Type I or Type II]' from indication heading for HAE due to C1-INH deficiency.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.