MedicaidPrior AuthMedium impact
NovoSeven RT and SevenFact (Recombinant Activated Factor VIIa) (Revised)
Humana·KY · Hematology, Critical Care, General Surgery +1 more·Medicaid
Effective date
Apr 22, 2026
We identified it
Jun 25, 2026
Summary
Humana has revised its prior authorization policy for NovoSeven RT and SevenFact (recombinant activated Factor VIIa) effective April 22, 2026, covering treatment of bleeding episodes and perioperative management in patients with hemophilia with inhibitors, congenital Factor VII deficiency, and Glanzmann's thrombasthenia with platelet refractoriness. The policy applies to Kentucky Medicaid and Medicare lines of business and requires prior authorization before dispensing these specialty coagulation factors.
Action Required
Before April 22, 2026: Update billing and prior authorization workflows in your system to ensure all requests for NovoSeven RT and SevenFact through Humana Kentucky Medicaid and Medicare plans are routed for prior authorization review. Billing team must verify patient eligibility for one of four covered indications: (1) hemophilia A/B with documented inhibitors or acquired hemophilia A for acute bleeding, (2) hemophilia with inhibitors for perioperative management (NovoSeven RT only), (3) congenital Factor VII deficiency for acute bleeding or perioperative use (NovoSeven RT only), or (4) Glanzmann's thrombasthenia with documented platelet transfusion refractoriness (NovoSeven RT only). SevenFact requests require age verification (12+ years). Flag and reject any requests for routine/scheduled prophylactic use, as this is an exclusion. Ensure prior authorization is obtained before claims submission to Humana; claims submitted without authorization will be denied. Clinical staff should obtain documentation of diagnosis and inhibitor status from ordering providers before submission.