MedicaidPrior AuthMedium impact
FEIBA NF (Anti-Inhibitor Coagulant Complex) (Revised)
Humana·KY · Hematology, Pharmacy·Medicaid
Effective date
Jul 20, 2017
We identified it
Jun 25, 2026
Summary
This is a revised Humana Medicaid pharmacy policy for FEIBA NF (Anti-Inhibitor Coagulant Complex) effective July 20, 2017, with the most recent revision dated April 22, 2026. The policy establishes prior authorization requirements for FEIBA NF in Kentucky Medicaid members with hemophilia A or B who have developed inhibitors to factor VIII or IX. Coverage is limited to three indications: control and prevention of bleeding episodes, perioperative management, and routine prophylaxis. The policy includes a black box warning for thromboembolic events and specifies dosing restrictions (maximum 200 units/kg/day).
Action Required
Before utilizing this policy for claim processing: (1) Billing team must verify all FEIBA NF claims for Kentucky Medicaid members require prior authorization before submission; (2) Implement pre-claim verification that member has documented diagnosis of hemophilia A or B AND confirmed inhibitors to factor VIII or factor IX; (3) Verify the prescribed indication is one of three covered uses: bleeding episode control/prevention, perioperative management, or routine prophylaxis; (4) Flag claims for dosing verification—claims exceeding 200 units/kg/day require special attention for thromboembolic risk documentation; (5) Update claim submission templates to capture inhibitor confirmation and indication type; (6) Appeals team should reference the April 22, 2026 revision date when responding to denials. Claims submitted without prior authorization or lacking documented inhibitor confirmation will be denied.