MedicaidPrior AuthMedium impact
Factor VIII Replacement Products (Hemophilia A) (New)
Humana·SC · Hematology, Pediatrics, Pharmacy·Medicaid
Effective date
Dec 17, 2025
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Factor VIII replacement products (hemophilia A treatments) effective December 17, 2025, for South Carolina Medicaid patients. All covered products including Advate, Altuviiio, Kogenate FS, Recombinate, Xyntha, and Xyntha Solofuse now require prior authorization for both routine bleeding prophylaxis and on-demand bleeding control/perioperative management.
Action Required
By December 17, 2025: Billing team must implement prior authorization requirements for all Factor VIII replacement products (Advate, Altuviiio, Kogenate FS, Recombinate, Xyntha, Xyntha Solofuse) for South Carolina Medicaid patients with hemophilia A. Update billing system to flag these medications for prior auth. Train staff to verify authorization before dispensing. Claims will be denied without proper prior authorization.