Coagadex® (coagulation factor X [Human])
EVICORE-MEDICAL_DRUG-AD2461D2
Coagadex is covered only for adults and children with hereditary Factor X deficiency for the three FDA‑approved indications (routine prophylaxis, on‑demand treatment/control of bleeding, and perioperative management) and is excluded for acquired or other non‑FDA‑approved indications. Authorization (up to 12 months) requires prescription by or consultation with a hematologist, IV administration with age‑ and weight‑based dosing (Dose = weight [kg] × desired FX rise [IU/dL] × 0.6 for <12 yrs or × 0.5 for ≥12 yrs), perioperative targets (pre‑surgery 70–90 IU/dL, post‑surgery ≥50 IU/dL), and documentation of diagnosis, indication, age/weight, and dosing calculations.
"Adults and children with hereditary Factor X deficiency"
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