Hereditary Angioedema (CPB 0782, reviewed 2025-11-13)

Effective immediately (2025-11-13): (1) Billing team must update authorization workflows to require precertification for ALL Aetna Hereditary Angioedema agents (Berinert, Ruconest, Cinryze, Dawnzera, Haegarda, Takhzyro) before claim submission. Contact Aetna specialty pharmacy at (866) 752-7021 or fax (888) 267-3277 for precertification. (2) Update provider documentation templates to capture: member's C1-INH antigenic and functional levels (if applicable), genetic testing results (if applicable), documented family history, trial of high-dose antihistamine therapy (cetirizine 40mg/day equivalent for at least one month if applicable), and prescriber specialty (must be HAE specialist). (3) For Berinert requests: Require evidence of one-month trial of Ruconest with documented contraindication, intolerance, or ineffective response before approval. (4) For continuation of prophylactic agents: Document 50%+ reduction in attack frequency and reduced acute medication use since starting prophylaxis. (5) For Dawnzera continuations: Verify dosing is every 8 weeks or document clinical rationale if different. (6) Front desk staff should inform patients that Site of Care utilization management applies to Cinryze administration. Failure to obtain precertification will result in claim denials.