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Blue Cross & Blue Shield of MississippiAll Plans · Coverage · Medical Policy · Hematology, PharmacyHigh impact

Hemophilia Therapies

Effective date
Oct 1, 2025
Identified
Jun 20, 2026

Summary

Qfitlia (fitusiran) is considered not medically necessary for hemophilia A and hemophilia B because there are other alternatives covered by the plan, and HCPCS J7174 is listed as new 10/01/2025 in the Not Medically Necessary Codes table. Prior authorization is required for Factor VIII and Factor IX therapies, and the policy lists the criteria for initial and renewal evaluations, including treatment logs and the actual prescribed dose with supporting documentation. Factor X is considered medically necessary for Factor X deficiency, and von Willebrand factor is considered medically necessary for von Willebrand disease.

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What to do

Action · 6 steps
01Already effective 10/01/2025: Check current applicability of J7174 before acting on this change.
02Perform a formulary drug search on the patient's member ID to ensure the prescription drug is covered under the benefit plan, because the medication may not be covered under a specific member's benefit plan.
03Get prior authorization for Factor VIII and Factor IX therapies, since prior authorization is required and starting on samples is not approvable.
04The prescriber must provide the actual prescribed dose with supporting documentation of the patient's age, patient's weight, severity of the factor deficiency, activity level, bleed history, current and desired trough level, inhibitor status, and intended use or regimen.
05Discuss with the patient that a treatment log must be maintained and a copy submitted via prescriber or pharmacy for renewal, with bleed entries including date and time, location and severity, how quickly the bleed was treated, and the treatment used including brand name, expiration date, lot number and units administered.
06Services related to delivery and/or administration of a medication determined to be not medically necessary will also be considered not medically necessary.

Codes mentioned

J7174

Original notice

Hemophilia Therapies
bcbsms.com · Always check the source before changing claims.
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Related changes

See all Blue Cross & Blue Shield of Mississippi changes →
State and School Employees' Health Insurance Plan - Hemophilia TherapiesMediumNo effective date · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list

Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesHematologyPharmacyCode J7174

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