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Policy Criteria Changes
Act
by Nov 15, 2025
Effective date
Nov 15, 2025
Identified
Jun 19, 2026
Summary
Two significant drug policy changes: Kogenate (Factor VIII product) has been discontinued by the manufacturer and removed from coverage, and Prademagene Zamikeracel (Zevaskyn) is now designated as non-covered for all indications under a new policy.
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What to do
by Nov 15, 2025 · 3 steps
01Billing team must update drug formulary systems to remove Kogenate from available Factor VIII products and ensure Prademagene Zamikeracel (Zevaskyn) is flagged as non-covered for all indications.
02Update prior authorization systems and provider alerts accordingly.
03Claims submitted for these products after the effective date will be denied.
Original notice
Policy Criteria Changes
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Related changes
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