Advate®, Adynovate®, Afstyla®, Altuviiio™, Eloctate®, Esperoct, Jivi®, Kogenate FS®, Kovaltry®, Obizur®, Novoeight®, Nuwiq®, Recombinate®, Xyntha® (antihemophilic factor [recombinant]) Hemofil M®, Koate-DVI® (antihemophilic factor [plasma de

Covers specified recombinant and plasma‑derived antihemophilic factor products for congenital hemophilia A (on‑demand, perioperative, routine prophylaxis) and Alphanate/Humate‑P/Koate‑DVI for von Willebrand disease, with Obizur covered only for acquired hemophilia A and expressly excluded from congenital hemophilia A. Key requirements: documented inhibitor screening (no inhibitor or <5 BU/mL, ≥5 BU/mL only when used as part of immune tolerance induction), age limits (Jivi ≥12 years; Obizur ≥18 years), failure/intolerance/contraindication to TWO standard‑half‑life rFVIII products after ≥3‑month trials before long‑acting rFVIII prophylaxis, IV use only, dosing/weight and clinical documentation, and approvals limited to 12 months.

"Acquired Hemophilia A (Obizur only): The individual is 18 years of age or older."

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