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HumanaMedicaid · Prior Auth · Medicaid · KY · Hematology, Pharmacy, PediatricsMedium impact

Factor IX Replacement Products (Hemophilia B) (Revised)

Act
immediately
Effective date
Jan 20, 2017
Identified
Jun 25, 2026

Summary

This is a revised Humana Medicaid policy (Kentucky) for Factor IX replacement products used to treat Hemophilia B. The policy was last revised on December 17, 2025 (1 day old) and requires prior authorization for eight Factor IX products. No substantive coverage changes are documented in this revision; the policy maintains existing approval criteria requiring confirmed congenital Hemophilia B diagnosis and use for prophylaxis, on-demand bleeding treatment, or perioperative management.

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What to do

immediately · 6 steps
01Billing team must verify this policy applies to your Kentucky Medicaid contracts.
02Confirm all Factor IX replacement product claims (AlphaNine SD, Alprolix, BeneFIX, Idelvion, Ixinity, Profilnine, Rebinyn, Rixubis) require prior authorization before submission in your billing system.
03Update claim submission procedures to require documented evidence of congenital Hemophilia B diagnosis and one of three approved uses: routine prophylaxis, on-demand bleeding treatment, or perioperative management.
04Train billing and front desk staff that this is a prior authorization requirement—claims submitted without pre-approval will be denied.
05Reference www.humana.com/PAL for current medically billed claim codes.
06Alert providers to ensure patient charts document medical necessity aligned with policy criteria before prescribing.

Codes mentioned

J7171J7172J7173J7174J7175J7176J7177J7178

Original notice

Factor IX Replacement Products (Hemophilia B) (Revised)
mcp.humana.com · Always check the source before changing claims.
View original ↗

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Related policy hubs

Humana policiesKY policy changesHematologyPharmacyPediatricsCode J7171Code J7172Code J7173Code J7174Code J7175Code J7176Code J7177Code J7178

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