Currentmedical mutual - ohioPolicy N/A

Hympavzi (marstacimab-hncq) prior authorization and coverage

Defines prior authorization criteria, dosing, renewal, billing codes, NDCs, covered diagnoses, and documentation requirements for marstacimab (Hympavzi) for routine prophylaxis of congenital Hemophilia A and B without inhibitors for commercial members of Medical Mutual - Ohio.

Policy Summary

Payermedical mutual - ohio

PolicyHympavzi (marstacimab-hncq) prior authorization and coverage

Policy CodePolicy N/A

Change TypeCoding transition (HCPCS)

Effective DateDec 31, 2024

Next Review Date

Key ActionPrior authorization is required; initial approval provided for 6 months and may be renewed every 12 months thereafter.

SourceLink

POLICY UPDATE CHANGES

HCPCS code J7172 effective 07/01/2025 replaces prior codes C9304 and J3590 which were discontinued 07/01/2025.

2Covered Indications (Hemophilia A, Hemophilia B)

600Max weekly billable units

>=12Minimum age

6 moInitial PA duration

Coverage Summary

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.

coverage_stance: covered_with_criteria; scope_summary: Defines prior authorization criteria, dosing, renewal, billing codes, NDCs, covered diagnoses, and documentation requirements for marstacimab (Hympavzi) for routine prophylaxis of congenital Hemophilia A and B without inhibitors for commercial members of Medical Mutual - Ohio; effective date: 2024-12-31; status: CURRENT; brief dosing indication: Loading dose 300 mg (two 150 mg subcutaneous injections) followed by maintenance 150 mg weekly, with possible escalation to 300 mg weekly per criteria.