CommercialPrior AuthHigh impact
Human Fibrinogen Concentrate Products (CPB 0792, reviewed 2026-04-27)
Aetna·Hematology, Cardiothoracic Surgery, Critical Care +1 more·Medical Policy
Effective date
Apr 27, 2026
We identified it
Aug 15, 2026
Summary
Aetna updated its medical policy for human fibrinogen concentrate products (Fesilty, Fibryga, and RiaSTAP) effective April 27, 2026. All three products now require precertification through Aetna's Special Case Precertification Unit before dispensing. Coverage criteria vary by product: Fesilty and RiaSTAP cover congenital fibrinogen deficiency and acute bleeding; Fibryga expands coverage to include acquired fibrinogen deficiency. All prescriptions must be from or in consultation with a hematologist.
Action Required
By April 27, 2026: (1) Billing team must implement mandatory precertification workflow for all fibrinogen concentrate claims (Fesilty, Fibryga, RiaSTAP) - create system alert requiring prior auth submission to Aetna's Special Case Precertification Unit at (855) 888-9046 before dispensing. (2) Update encounter forms and provider documentation templates to require hematology specialty verification (prescription from or in consultation with hematologist). (3) Establish separate approval pathways in billing system based on product and indication: Fesilty/RiaSTAP for congenital fibrinogen deficiency only; Fibryga for both congenital AND acquired fibrinogen deficiency. (4) Staff must deny or hold all fibrinogen concentrate claims lacking precertification approval and route to providers for resubmission. (5) Clinical staff should communicate to hematology departments that all fibrinogen concentrate orders must include precertification before pharmacy processes medication. Failure to obtain precertification will result in claim denials and member out-of-pocket responsibility.