Description: Ecallantide injection
Unit: 1 mg
Pay quarter: Q4 2023
Dosage and Frequency
• 30mg SQ PRN
An additional dose may be administered within 24 hours if attack persists.
Calculate drug reimbursement
(ASP: $15,063.54, Margin: $903.81)
# Units to bill:30
Prior auth criteria for Kalbitor may include but is not limited to:
1. Patient is 6 years of age or older.
2. Patient has been diagnosed with hereditary angioedema (HAE).
3. Patient has failed or is intolerant to other treatments for HAE, such as fresh frozen plasma, C1-inhibitor concentrate, or danazol.
4. Patient has documented response to Kalbitor treatment.
5. Patient has no contraindications for Kalbitor.
6. Patient has not experienced any serious adverse reactions to Kalbitor.
7. Patient is prescribed a course of treatment that is no longer than 8 days.
8. Patient is not pregnant or nursing.
Insurance prior auth guidelines:
KALBITOR (TAKEDA PHARMACEUTICALS AMERICA, INC.)