Hereditary Angioedema (CPB 0782, reviewed 2026-09-10)
Summary
Aetna Clinical Policy Bulletin 0782 sets the criteria for hereditary angioedema (HAE) drugs under commercial medical plans, and precertification is required for these agents in applicable plan designs. Cinryze, Dawnzera, Haegarda and Takhzyro are considered medically necessary for prevention of HAE attacks when they are prescribed by or in consultation with a prescriber who specializes in the management of HAE, are not used in combination with another prophylaxis medication, and the member meets the initial criteria, including C1 inhibitor deficiency confirmed by laboratory testing or a normal C1 inhibitor with a qualifying pathogenic variant or a family history of angioedema refractory to high-dose antihistamine therapy for at least one month. Berinert is considered medically necessary for treatment of acute attacks only when the member has a contraindication, intolerance or ineffective response to the equivalent alternative Ruconest, tried for one month, and all other indications of these agents are considered experimental, investigational or unproven.
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