Traditional MedicarePrior AuthLow impact
Qfitlia™ (fitusiran) subcutaneous injection (Revised)
Humana·KY, SC · Hematology, Pediatrics·Medicaid
Effective date
Jun 25, 2025
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Qfitlia (fitusiran) subcutaneous injection for hemophilia A and B prophylaxis. Requires strict criteria including severe hemophilia diagnosis, failed standard therapy, specific antithrombin activity levels, and ongoing monitoring requirements.
Action Required
By June 25, 2025: Billing team must implement prior authorization requirements for Qfitlia (fitusiran) subcutaneous injection claims. Ensure providers document severe hemophilia A/B diagnosis, failed standard therapy or contraindications, antithrombin activity levels 60% or greater before initiation, and planned prophylactic use. Claims without prior authorization will be denied.