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    v1.0.31
    OpenPayerPolicy UpdatesHematology/OncologyCigna Vonvendi Prior Auth Policy 2026 | OpenPayer
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    CurrentCignaPolicy IP0555

    Vonvendi

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    This policy governs prior authorization and medical-necessity coverage for Vonvendi for patients with von Willebrand disease when the indication, specialist involvement, and dosing criteria are met.

    Policy Summary
    PayerCigna
    PolicyVonvendi
    Policy CodePolicy IP0555
    Change TypeAge restriction removed
    Effective DateNov 15, 20261d
    Last ReviewNov 5, 2026
    Next Review DateN/A
    Key ActionObtain prior authorization and document hematologist prescribing or consultation, the treatment purpose, and the proposed dose and frequency.
    SourceLink
    POLICY UPDATE CHANGES

    The prior age restriction for Vonvendi treatment of von Willebrand disease was removed.

    1 yearStandard approval duration
    60 IU/kgRoutine prophylaxis dose
    Twice weeklyRoutine prophylaxis frequency
    900 IU/kgOn-demand or perioperative dose
    J7179

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Covered HCPCS code
    Prior authorizationUtilization management

    Medical Necessity Criteria

    FDA-approved indication: von Willebrand disease

    Covered for the FDA-approved von Willebrand disease indication when all of the following are met:

    Vonvendi medical-necessity criteria

    • Specialist requirement: Vonvendi is prescribed by or in consultation with a hematologist.Hematologist prescribing or consultation

    • Covered dosing regimen

      • A. On-demand treatment and control of bleeding episodes: Use up to 900 IU/kg intravenously no more frequently than once every 28 days.Up to 900 IU/kg IV; no more frequently than once every 28 days
      • B. Perioperative management of bleeding: Use up to 900 IU/kg intravenously no more frequently than once every 28 days.Up to 900 IU/kg IV; no more frequently than once every 28 days
      • C. Routine prophylaxis: Use up to 60 IU/kg intravenously no more frequently than twice weekly.Up to 60 IU/kg IV; no more frequently than twice weekly

    Vonvendi for any use other than the covered von Willebrand disease indication is considered not medically necessary.

    Use of Vonvendi for any other indication is considered not medically necessary.

    Coding and Dosing Parameters

    Considered Medically Necessary HCPCS CodeHCPCSCovered
    J7179Injection, von Willebrand factor (recombinant), (Vonvendi), 1 IU VWF:RCo
    On-demand treatment and control of bleeding episodes
    Maximum doseUp to 900 IU/kg
    RouteIntravenously
    FrequencyNo more frequently than once every 28 days
    Perioperative management of bleeding
    Maximum doseUp to 900 IU/kg
    RouteIntravenously
    FrequencyNo more frequently than once every 28 days

    Authorization and Submission Requirements

    Prior Authorization

    Prior Authorization Required

    Prior authorization is required for benefit coverage of Vonvendi. Approval is recommended only when the applicable coverage criteria and dosing requirements are met.

    Documentation Required

    Hematologist Involvement and Approval Duration

    Vonvendi must be prescribed by, or used in consultation with, a physician who specializes in the condition being treated because of the specialized diagnostic, monitoring, and long-term efficacy requirements. For von Willebrand disease, approval is for 1 year; extended approval is allowed when the patient continues to meet the criteria and dosing requirements.

    • A hematologist must prescribe or be consulted.
    • Continuation requests must document that criteria and dosing requirements remain satisfied.

    Clinical Background

    Vonvendi is a recombinant von Willebrand factor (VWF) administered by intravenous infusion. It is indicated for adults requiring routine prophylaxis to reduce bleeding episodes and for adults and pediatric patients requiring on-demand treatment or perioperative management of bleeding associated with von Willebrand disease. Von Willebrand disease is an inherited bleeding disorder involving deficient or impaired VWF, which supports platelet adhesion and stabilizes factor VIII.

    Key Terms

    Von Willebrand disease
    DefinitionAn inherited bleeding disorder caused by a deficiency or impairment of von Willebrand factor (VWF).
    Platelet adhesionVWF mediates platelet adhesion at sites of vascular injury.
    Factor VIII stabilizationVWF binds and stabilizes Factor VIII.
    Vonvendi
    Product definitionVonvendi is von Willebrand factor (VWF).
    TechnologyVonvendi is produced by recombinant technology.
    AdministrationAdministered by intravenous infusion.
    Policy Summary
    PayerCigna
    PolicyVonvendi
    Policy CodePolicy IP0555
    Change TypeAge restriction removed
    Effective DateNov 15, 20261d
    Last ReviewNov 5, 2026
    Next Review DateN/A
    Key ActionObtain prior authorization and document hematologist prescribing or consultation, the treatment purpose, and the proposed dose and frequency.
    SourceLink
    On This Page
    Medical Necessity CriteriaCoding and Dosing ParametersAuthorization and Submission RequirementsClinical BackgroundKey Terms
    Routine prophylaxis
    Maximum doseUp to 60 IU/kg
    RouteIntravenously
    FrequencyNo more frequently than twice weekly
    Maximum supply allowance
    Prophylactic dosingProphylactic dosing is included in the maximum supply allowance per 28 days.
    Acute bleeding or perioperative managementAllowance for three days of acute bleeding or perioperative management per 28 days.
    Doses exceeding allowanceDoses exceeding this quantity are reviewed on a case-by-case basis by a clinician.
    Documentation Required

    Clinical and Dosing Documentation

    Submit documentation establishing the covered diagnosis, treatment purpose, prescribed dose, route, and frequency. Requests should identify whether treatment is for on-demand bleeding control, perioperative management, or routine prophylaxis and include supporting clinical documentation for the requested regimen.

    • Covered diagnosis: von Willebrand disease.
    • On-demand treatment or perioperative management: up to 900 IU/kg intravenously no more frequently than once every 28 days.
    • Routine prophylaxis: up to 60 IU/kg intravenously no more frequently than twice weekly.
    Denial Risk

    Noncovered Indication

    Vonvendi for any use other than the covered indication of von Willebrand disease is considered not medically necessary and may be denied.

    • Ensure the submitted diagnosis and treatment indication support von Willebrand disease.
    Denial Risk

    Dose Exceeds Policy Limits

    Doses outside the established policy limits will be reviewed case by case by a clinician, such as a Medical Director or Pharmacist, and may not be approved. The policy's maximum doses account for prophylaxis plus up to three days of acute bleeding or perioperative management per 28 days.

    • Doses exceeding the policy quantity limits require individual clinical review.
    • Approval is not guaranteed for dosing outside the established limits.
    Billing Rule

    Use Applicable Covered Coding

    Claims may be denied as not covered when they lack an applicable covered diagnosis or procedure code. Providers must use the most appropriate codes that are effective on the submission date; deleted or otherwise ineffective codes may not be eligible for reimbursement.

    • Covered HCPCS: J7179 — Injection, von Willebrand factor (recombinant), (Vonvendi), 1 IU VWF:RCo.
    • The code list may not be all-inclusive.
    • Services billed for conditions or diagnoses not covered under the policy are not reimbursable.