CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Haegarda (C1 esterase inhibitor) — Coverage Criteria for Prophylaxis of Hereditary Angioedema

Covers prior authorization, documentation, clinical criteria, and continuation requirements for Haegarda used for routine prophylaxis of hereditary angioedema (HAE) in eligible members age 6 and older.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyHaegarda (C1 esterase inhibitor) — Coverage Criteria for Prophylaxis of Hereditary Angioedema

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization with laboratory or genetic confirmation (or documented family history plus antihistamine‑refractory attacks) and do not combine Haegarda with other HAE prophylactic agents.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Age ≥ 6minimum age for FDA-approved prophylaxis

6 monthsauthorization length

≥50% reductioncontinuation threshold

C1‑INH <50%lab functional threshold

Coverage Criteria for Haegarda (C1-INH) Prophylaxis

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