Harvard Pilgrim is covering the new-to-market drug Hemlibra for commercial members with prior authorization. The FDA approved Hemlibra (emicizumab-kxwh) in November 2017 to prevent or reduce the frequency of bleeding episodes in adult and pediatric patients with hemophilia A who have developed antibodies called Factor VIII (FVIII) inhibitors.
Effective immediately, Harvard Pilgrim will cover Hemlibra with prior authorization for the treatment of hemophilia A when laboratory testing confirms that the patient has a history of high-inhibitor titer (i.e., = 5 Bethesda units per milliliter). Initial authorizations will be for 6 months, and may be expanded to 12 months for patients who meet all initial authorization criteria and achieve and maintain reduction in the frequency of bleeding episodes.
As a reminder, CVS Health–NovoLogix oversees our prior authorization program for medical drugs to optimize treatment outcomes and promote the safe and cost-effective use of these medications. To request authorization for Hemlibra, please contact CVS Health–NovoLogix via phone (844-387-1435) or fax (844-851-0882). For complete information, please refer to our new Hemlibra Medical Review Criteria and the associated prior authorization request form.