Corifact (Factor XIII Concentrate [human])
Defines utilization management, prior authorization recommendations, approved indication, dosing limits, prescribing specialist requirements, and non-covered circumstances for Corifact (Factor XIII concentrate) on the medical benefit.
Annual Revision with no criteria changes (Review Date 12/04/2024).
Annual Revision (Review Date 11/08/2023) previously noted with no criteria changes.
Coverage Summary
Corifact is a human Factor XIII concentrate indicated for the treatment of congenital Factor XIII deficiency. The disorder is rare (estimated ~1 in 2 million for Factor XIIIA deficiency) and is associated with bleeding complications including delayed wound healing, soft tissue and subcutaneous bleeding, central nervous system (CNS) hemorrhage, and recurrent miscarriage. Treatment options include fresh frozen plasma, cryoprecipitate, Corifact, or recombinant Factor XIIIA (Tretten).