CommercialPrior AuthHigh impact
Fidanacogene Elaparvovec-dzkt (Beqvez) (CPB 1060, reviewed 2026-04-20)
Aetna·Hematology·Medical Policy
Effective date
Apr 20, 2026
We identified it
Aug 15, 2026
Summary
Aetna has established a new clinical policy (CPB 1060, effective 2026-04-20) for fidanacogene elaparvovec-dzkt (Beqvez), a gene therapy for hemophilia B. This one-time intravenous infusion requires mandatory precertification, must be administered at Aetna Institutes GCIT Network facilities, and has strict patient selection criteria including age ≥18, no prior Factor IX inhibitors, negative AAVRh74var antibody testing, and documented uncontrolled disease despite prophylactic therapy. Billing teams must implement prior authorization workflows and ensure claims route through designated GCIT network providers.
Action Required
By 2026-04-20: (1) Billing team must configure system to REQUIRE precertification for HCPCS code J1414 (fidanacogene elaparvovec-dzkt) on all Aetna commercial claims. (2) Providers must submit precertification requests via phone (866) 752-7021 or fax (888) 267-3277 with Statement of Medical Necessity (SMN) forms available through Specialty Pharmacy Precertification. (3) Update billing system to ONLY ALLOW J1414 billing when the administering facility is an Aetna Institutes GCIT Designated Network location—flag non-network facility claims for rejection. (4) Hematology providers must document in encounter forms: patient age ≥18, Factor IX inhibitor test results (within 30 days, <0.6 BU), AAVRh74var antibody test (negative), baseline labs (hemoglobin ≥11 g/dL, platelets ≥100,000, creatinine ≤2.0 mg/dL), hepatic function panel status, liver imaging results (ultrasound/elastography), hepatitis/HIV status, and prior gene therapy history. (5) Front desk staff must verify network status and precertification confirmation before scheduling. (6) Claims submitted without precertification or from non-designated facilities will be denied. (7) Update superbills and EMR templates to include mandatory hemophilia B treatment pathway fields and GCIT network verification.