Hereditary Angioedema (HAE)
Effective 04/01/2026, the BCBSMS hereditary angioedema policy added Andembry (garadacimab-gxii), Dawnzera (donidalorsen), and Ekterly (sebetralstat) to its list of drugs, and Sajazir (icatibant) was added effective the same date. The revised criteria cover documentation of recurrent angioedema episodes and HAE subtype, and add separate criteria for acute attack treatment and for routine prophylaxis. Dawnzera and Ekterly are considered not medically necessary because other formulary alternatives are covered by the Plan for both acute and prophylactic treatment of HAE attacks.