CommercialPrior AuthMedium impact
Human Fibrinogen Concentrate Products (CPB 0792, reviewed 2026-10-05)
Aetna·Hematology, Cardiothoracic Surgery, General Surgery +1 more·Medical Policy
We identified it
Oct 10, 2026
Summary
Aetna's Clinical Policy Bulletin 0792 (reviewed 2026-10-05) establishes medical necessity criteria for three human fibrinogen concentrate products (Fesilty, Fibryga, and RiaSTAP) in commercial medical plans. The policy requires precertification for all three products and specifies distinct approval criteria by product and indication (congenital vs. acquired fibrinogen deficiency). This is a policy review with no stated effective date change; verify current applicability with Aetna before implementing billing changes.
Action Required
Verify current applicability: Confirm with Aetna whether this 2026-10-05 policy review reflects active coverage criteria for your commercial plan members. If implementing or updating billing workflows for human fibrinogen concentrate products (Fesilty, Fibryga, RiaSTAP): (1) Billing team should ensure precertification is obtained prior to claim submission by calling Aetna's Special Case Precertification Unit at (855) 888-9046; (2) Verify that prescribers are hematologists or consulting with hematologists before processing claims; (3) Update authorization criteria in billing system to distinguish between Fesilty (congenital fibrinogen deficiency only), Fibryga (congenital and acquired fibrinogen deficiency), and RiaSTAP (congenital fibrinogen deficiency with expanded prophylaxis coverage); (4) Flag claims for non-covered indications (e.g., trauma-associated hemorrhage, obstetric hemorrhage, dysfibrinogenemia) as experimental/investigational for denial or appeal review. Claims without precertification or from non-hematology providers will be subject to denial.