Medicare AdvantagePrior AuthLow impact
Ruconest (C1 esterase inhibitor, recombinant) (Revised)
Humana·KY, SC · Allergy & Immunology·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana has revised its prior authorization policy for Ruconest (C1 esterase inhibitor) used to treat hereditary angioedema (HAE) attacks. The policy now includes 8 specific criteria that must be met for approval, including lab documentation requirements and step therapy with generic icatibant for most plans.
Action Required
By January 1, 2025: Billing and clinical staff should review the 8 new prior authorization criteria for Ruconest. Ensure patients have proper HAE diagnosis documentation including C4 levels, C1INH levels, and C1q levels before submitting requests. For non-Medicare Part B continuation requests, document previous trial, contraindication, or intolerance to generic icatibant. Failure to meet criteria will result in authorization denials.