Medicare AdvantagePrior AuthMedium impact
Alhemo® subcutaneous pen injector (Revised)
Humana·Hematology, Pediatrics·Medicare Advantage
Effective date
Apr 23, 2025
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Alhemo® (concizumab-mtci) subcutaneous pen injector, a hemophilia treatment, requires specific criteria to be met for Medicare Advantage coverage including diagnosis documentation, step therapy requirements, and plasma concentration monitoring. Policy establishes strict approval criteria for both Hemophilia A and B patients with renewal requirements based on therapeutic monitoring.
Action Required
By April 23, 2025: Billing team must implement prior authorization requirements for Alhemo® subcutaneous pen injector requests for Medicare Advantage patients. Update billing system to flag hemophilia A/B patients requiring step therapy documentation, factor inhibitor history, and plasma concentration monitoring via Concizumab ELISA testing. Create documentation checklists for providers to ensure compliance with approval criteria. Claims without proper prior authorization will be denied.