UTILIZATION MANAGEMENT MEDICAL POLICY
Defines prior authorization recommendation and coverage criteria (indications, dosing, duration, prescriber specialty) for a list of recombinant, extended half-life, standard half-life, and plasma-derived Factor VIII and von Willebrand-containing products for Hemophilia A and von Willebrand disease for CareSource members.
Annual Revision: Removed Helixate/Helixate FS and Monoclate P from the policy as both products are obsolete.
Selected Revision: Added dosing for Humate P, Alphanate, and Wilate for von Willebrand disease routine prophylaxis.
Selected Revision: Added Dosing for Adynovate, Eloctate, Esperoct, and Jivi immune tolerance therapy (immune tolerance induction).
Annual Revision: No criteria changes noted for prior years; latest Annual Revision review date 02/19/2025.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.