MedicaidPrior AuthMedium impact
Factor IX Replacement Products (Hemophilia B) (New)
Humana·SC · Hematology, Internal Medicine, Pediatrics·Medicaid
Effective date
Dec 17, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid South Carolina has established a new prior authorization policy for Factor IX replacement products (BeneFIX, Idelvion, Ixinity, Profilnine) used to treat Hemophilia B, effective December 17, 2025. All requests must meet specific criteria including confirmed congenital hemophilia B diagnosis and appropriate use for bleeding prophylaxis, treatment, or perioperative management.
Action Required
By December 17, 2025: Billing team must implement prior authorization requirements for all Factor IX products (BeneFIX, Idelvion, Ixinity, Profilnine) for Humana Medicaid South Carolina members. Ensure providers document congenital hemophilia B diagnosis and specify use for routine bleeding prophylaxis, on-demand treatment, or perioperative management before submitting claims. Visit www.humana.com/PAL for specific medical coding information. Claims without prior authorization will be denied.