CurrentMass General Brigham Health PlanPolicy N/A

Corifact (factor XIII concentrate [human]) coverage

Policy governs prior authorization requirements for Corifact (factor XIII concentrate [human]) under the pharmacy benefit for Mass General Brigham Health Plan commercial/exchange members, including indications covered, continuity rules for members new to plan, and authorization durations.

Policy Summary

PayerMass General Brigham Health Plan

PolicyCorifact (factor XIII concentrate [human]) coverage

Policy CodePolicy N/A

Change TypeMinor — no material clinical or coverage changes

Effective DateJun 1, 2025

Next Review DateMay 14, 2025

Key ActionObtain prior authorization under the pharmacy benefit for members with a diagnosis of congenital Factor XIII deficiency.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Prior AuthorizationProgram type

PharmacyBenefit

12 monthsApproval duration

Commercial/ExchangePlans

Congenital FXIII deficiencyIndication covered

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.

Other indicationsNon-covered

Coverage Criteria for Corifact (factor XIII concentrate [human])

Initial Therapy

Covered when ALL of the following are met

Initial Authorization: Member has a diagnosis of Factor XIII deficiency.

Authorization may be granted under prior authorization for this indication.

Continuation of Therapy

Reauthorization when ALL of the following are met

Continuation Authorization: Member is experiencing benefit from therapy (e.g., reduced frequency or severity of bleeds).

Reauthorization approvals are granted for up to 12 months.

Not Medically Necessary

Not covered

Experimental/Investigational: All indications other than congenital Factor XIII deficiency.

These are considered not medically necessary.

All indications other than congenital Factor XIII deficiency are excluded from coverage for Corifact. These uses are considered experimental/investigational and not medically necessary.

Use of Corifact for any indication other than congenital Factor XIII deficiency is not medically necessary and will not be covered.

Provider Actions and Authorization Rules

Prior Authorization

Prior Authorization Required

Prior authorization is required for Corifact under the pharmacy benefit.

Pharmacy benefit prior authorization required
Specialty drug — must be filled at a contracted specialty pharmacy

Note

New-to-plan continuity

Authorization may be granted for members new to the plan within the past 90 days who are currently receiving the requested medication. This does not apply when the medication was provided only as samples or through the manufacturer's patient assistance programs.

New-to-plan continuity window: 90 days
Excludes samples and manufacturer patient assistance program supply

Indicated Population

Indicated population

IndicationAdult and pediatric patients with congenital Factor XIII deficiency for routine prophylactic treatment and peri-operative management of surgical bleeding.

ExclusionsAll other indications are considered experimental/investigational and not medically necessary.

Benefit designationPharmacy benefit (prior authorization required).

Plans coveredCommercial/Exchange members.

Approval durationUp to 12 months for initial and reauthorization approvals.

Background on Corifact

Corifact is a coagulation factor XIII concentrate (human) indicated for routine prophylactic treatment and for peri‑operative management of surgical bleeding in adult and pediatric patients with congenital Factor XIII deficiency.

Policy Summary

PayerMass General Brigham Health Plan

PolicyCorifact (factor XIII concentrate [human]) coverage

Policy CodePolicy N/A

Change TypeMinor — no material clinical or coverage changes

Effective DateJun 1, 2025

Next Review DateMay 14, 2025

Key ActionObtain prior authorization under the pharmacy benefit for members with a diagnosis of congenital Factor XIII deficiency.

SourceLink

On This Page

Note

New-to-plan continuity limitation

Members new to the plan who are not currently receiving the medication (or who received it only as samples or via manufacturer's assistance) have limitations — continuity provisions do not apply and a standard prior authorization must be submitted.

Continuity limitation applies when member did not receive active therapy prior to enrollment or received only samples/assistance

Documentation Required

Required diagnosis for initial requests

Authorization may be granted when the member has a diagnosis of congenital Factor XIII deficiency.

Diagnosis required: Factor XIII deficiency

Documentation Required

Required clinical documentation

Documentation must support a diagnosis of Factor XIII deficiency for initial requests and evidence of benefit for continuation requests (e.g., reduced frequency or severity of bleeds).

Initial requests: clinical documentation confirming congenital Factor XIII deficiency
Continuation requests: evidence of clinical benefit (reduced bleed frequency/severity)

Denial Risk

Non-covered indications

Requests for indications other than congenital Factor XIII deficiency are considered experimental/investigational and not medically necessary.

Non-covered: any indication other than congenital Factor XIII deficiency
Treatment outside labeled indication considered experimental/investigational