Clotting Factors, Coagulant Blood Products, & Other Hemostatics
Medical necessity and coverage criteria for clotting factors, coagulant blood products, and other hemostatics for bleeding disorders (e.g., hemophilia A/B, von Willebrand disease, congenital factor XIII deficiency). Applies to UnitedHealthcare commercial members per this policy.
Antithrombin-directed siRNA (Qfitlia) and TFPI antagonist agents (Alhemo and Hympavzi) were added to the policy's applicable products and brand-name list.
Revised coverage criteria for emicizumab (Hemlibra); removed prescriber attestation limiting use of extended half-life factor VIII for breakthrough bleeding.
Removed Helixate FS and Mononine from the list of applicable brand names.
Added HCPCS codes C9399, J3490, J3590, and J7172 to Applicable Codes.
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.