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Hemophilia Drug Prior Authorization

To contribute to improved transparency around clinical management, Magellan Rx Hemophilia Management services will be used to perform utilization management and oversight of specialty pharmacy dispensing as part of this 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. 

Please review the hemophilia drug policies posted on this site.

How to Submit a Prior Authorization Request

  • Prescribers may submit a prior authorization request online through eligibility and benefits on the website on the back of your patient’s ID card or by calling Magellan Rx at
  • Specialty pharmacies seeking initial prior authorization on behalf of the prescriber should complete the Hemophilia Prior Authorization Form or call MagellanRx at

After initial approval of a hemophilia drug PA, specialty pharmacies dispensing the hemophilia drugs will also be required to complete the Hemophilia Case Review Form below to obtain a dose authorization from Magellan Rx prior to each dispensing of the drug. Through this additional dose authorization, Magellan Rx will ensure that appropriate assay management, inventory management, and patient engagement is being provided.

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Hemophilia Case Review Form