Medicare AdvantagePrior AuthLow impact
Coagadex® (Coagulation Factor X [Human]) (Revised)
Humana·KY, SC · Hematology, Pharmacy·Medicaid
Effective date
Dec 17, 2025
We identified it
Jun 25, 2026
Summary
Humana revised its Coagadex (Coagulation Factor X [Human]) pharmacy coverage policy effective December 17, 2025, covering Medicare and Medicaid members in Kentucky and South Carolina. The policy maintains prior authorization requirements for this blood coagulation factor used to treat hereditary Factor X deficiency. No substantive coverage criteria changes are evident; the revision appears to be a routine update of existing policy language and references.
Action Required
By December 17, 2025: Billing team should verify that the practice's prior authorization submission procedures for Coagadex align with Humana's current policy. If your practice bills for this medication in Kentucky or South Carolina under Medicaid or Medicare plans, confirm that prior authorization requests include documentation of hereditary Factor X deficiency diagnosis and the specific indication (on-demand treatment, perioperative management, or routine prophylaxis). No coding changes are required, but staff should reference the updated policy version at humana.com/PAL for the most current prior authorization requirements. Update any internal policy references or checklists to cite the December 17, 2025 revision date to avoid reliance on outdated versions.