Medicare AdvantagePrior AuthMedium impact
Hympavzi Pen subcutaneous pen injector (Revised)
Humana·Hematology, Pediatrics·Medicare Advantage
Effective date
Feb 26, 2025
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Hympavzi Pen (marstacimab-hncq) subcutaneous injection for hemophilia A and B prophylaxis in Medicare Advantage plans. Requires documentation of severe disease or target joints, step therapy with clotting factor replacement, and excludes patients on immune tolerance induction therapy.
Action Required
By February 26, 2025: Billing team must update prior authorization system for Hympavzi Pen (marstacimab-hncq) for Medicare Advantage hemophilia patients. Ensure providers document severe disease criteria (less than 1% factor VIII/IX or target joints with ≥3 bleeds in 6 months), prior failure/contraindication to clotting factor therapy, and prophylactic use indication. Claims will be denied without proper prior authorization.