Traditional MedicarePrior AuthLow impact
Kalbitor (ecallantide) (Revised)
Humana·KY, SC · Allergy & Immunology·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has updated prior authorization requirements for Kalbitor (ecallantide) for treating hereditary angioedema (HAE) in Medicare and Medicaid patients. The policy now requires specific lab documentation including C1q levels and mandates step therapy with generic icatibant for most requests, with exceptions for Medicare Part B continuations and all Medicaid requests.
Action Required
By January 1, 2025: For providers treating hereditary angioedema patients, update prior authorization protocols for Kalbitor (ecallantide) to include C1q lab levels in documentation and ensure step therapy with generic icatibant is documented before requesting authorization. Allergy/immunology specialists should verify all eight criteria are met and documented before submitting requests to avoid denials.