Concizumab-mtci (Alhemo) — Routine Prophylaxis for Hemophilia A and B
Clinical coverage criteria for prior authorization and continued use of concizumab-mtci (Alhemo) for routine prophylaxis to prevent or reduce bleeding episodes in patients age ≥12 with hemophilia A or B, with or without inhibitors. Applies to Commercial, HIM, and Medicaid lines of business affiliated with Centene.
Added new indication for hemophilia A and B without inhibitors.
Provider attestation requirement that Concizumab ELISA will be completed 4 weeks post-Alhemo initiation.
Requirement that Hemlibra and other prophylactic factor products be discontinued while on Alhemo.
Initial approval duration revised to 2 months; continued approval durations revised (Medicaid/HIM 12 months; Commercial 6 months or to member renewal date).
HCPCS code J7173 added; older codes C9399 and J3590 removed.
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