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Draft Hemophilia Drug Policies

Draft policies are listed below. If there are no policies listed, it means there are currently no policies in draft status.

Drug policies are based on:

  • Information in FDA-approved package inserts (and black box warnings, alerts or other information disseminated by the FDA, as applicable);
  • Research of current medical and pharmacy literature; and/or,
  • Review of common medical practices in the treatment and diagnosis of disease.

Pharmacy drug policies provide a guide to coverage. Pharmacy policies are not intended to dictate to providers how to practice medicine. Providers should exercise their medical judgment in providing the care they feel is most appropriate for their patients.

Note: Coverage is subject to member's specific benefits. Group-specific policies will supersede these policies, when applicable. Always verify member eligibility and benefits.

Magellan Rx Hemophilia Management services will be used to perform utilization management and oversight of specialty pharmacy dispensing as part of the Hemophilia Drug Prior Authorization Program. 
 
For groups that have their pharmacy benefits carved in and participate in utilization management, Magellan Rx will perform the prior authorization (PA) drug reviews. The PA reviews will ensure that optimal products and dosing are being prescribed. Hemophilia products will be billed as self-administered products under the member's pharmacy benefit.

Comment on Draft Drug Policies

Participating providers are invited to submit scientific, evidence-based information, professional consensus opinions and other information supported by medical literature relevant to these draft policies for consideration.

Comments are accepted for 45 days from the posting date listed on the draft policy.

Make sure your voice is heard by providing feedback directly to us:
 

Credence Blue Cross and Blue Shield Service Center
Attn: Pharmacy Department
P.O. Box 10447
Birmingham, AL 35202

Fax: 205-220-9576

Draft Policies

Policy # Policy Title Print View
PH-90337 Hemophilia Products – Anti-Inhibitor Coagulant Complex: Feiba
PH-90338 Hemophilia Products – Coagulation Factor XIII A-subunit: Tretten®
PH-90339 Hemophilia Products – Factor IX: AlphaNine SD, Alprolix, BeneFIX, Idelvion, Ixinity, Mononine, Profilnine, Rebinyn, and Rixubis
PH-90341 Hemophilia Products – Factor X: Coagadex
PH-90342 Hemophilia Products – Factor XIII: Corifact®
PH-90343 Hemophilia Products – Factor VIIa: NovoSeven RT ®; Sevenfact ®
PH-90345 Hemophilia Products – Factor VIII/VWF Complex: Alphanate, Humate-P®, Wilate
PH-90349 Hemophilia Products – Anti-Inhibitor Antibody: Hemlibra ® (emicizumab-kxwh)