Andembry® (garadacimab-gxii) - Prior Authorization/Notification - UnitedHealthcare Commercial Plans
Prior authorization/notification policy for Andembry (garadacimab-gxii) for prophylaxis of hereditary angioedema (HAE) in patients aged 12 years and older under UnitedHealthcare Commercial Plans; defines approval criteria, authorization duration, and program notes.
New prior authorization program for Andembry (garadacimab-gxii) established.
Coverage Summary
Background: Andembry is an activated Factor XII (FXIIa) inhibitor (monoclonal antibody) indicated for prophylaxis to prevent attacks of hereditary angioedema (HAE) in adult and pediatric patients aged 12 years and older. Coverage stance: covered_with_criteria. Scope summary: Prior authorization/notification policy for Andembry (garadacimab-gxii) for prophylaxis of hereditary angioedema (HAE) in patients aged 12 years and older under UnitedHealthcare Commercial Plans; defines approval criteria, authorization duration, and program notes. Authorization duration threshold: 12 months. Effective date: 2026-01-01. Last review (P&T approval) date: 2025-11-01.
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.