Factor IX Products

Evicore covers Factor IX products for congenital hemophilia B for on‑demand bleeding, routine prophylaxis, and perioperative management (Profilnine is additionally allowed as a compendial off‑label option for Factor II and Factor X deficiencies); IV use only. Approval (up to 12 months) requires documented diagnosis, prescription by or in consultation with a hemophilia specialist, adherence to product‑ and age‑specific dosing and target FIX level guidance with supporting weight/dosing calculations/observed recovery, and medical record evidence of bleeding/prophylaxis/perioperative need.

"Hemophilia B (congenital Factor IX deficiency) — On-demand treatment and control of bleeding episodes"

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