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ICATIBANT INJ,SOLN

Generic Name: ICATIBANT INJ
Brand Names: FIRAZYR, SAJAZIR
Drug Class: IMMUNOLOGICAL AGENTS,OTHER
Formulary Status: Non-Formulary Requires prior authorization
Copay Tier: 2
Last Updated: August 1, 2026

Clinical Criteria Summary

Exclusion Criteria

Concomitant use with another acute therapy agent for HAE (e.g., ecallantide or sebetralstat)

Inclusion Criteria

Restricted to VA / VA Community Care allergy/immunology, dermatology, or emergency medicine providers or locally designated expert
Suspected bradykinin-mediated angioedema

Source Documents

Download CFU PDF: Icatibant FIRAZYR CFU Aug 2026