Factor XIII Products Corifact® (factor XIII concentrate [human]) Tretten® (coagulation factor XIII A-subunit [recombinant])
EVICORE-MEDICAL_DRUG-B96F1157
(1) Covered/excluded: Corifact is covered for routine prophylaxis and perioperative management and Tretten for routine prophylaxis only for FDA‑approved congenital Factor XIII deficiency/FXIII‑A subunit deficiency; other indications are not covered. (2) Key requirements: therapy must be prescribed by or in consultation with a hematologist, IV only, approvals up to 12 months with documented diagnosis and FXIII activity levels (Corifact 40 IU/kg q28 days ±5 IU/kg to maintain 5–20% trough; perioperative Corifact individualized by activity/surgery/response; Tretten 35 IU/kg monthly targeting ≥10% trough with dose adjustment if needed) and perioperative documentation of type of surgery and clinical response.
"Corifact is a Factor XIII concentrate indicated for routine prophylactic treatment and perioperative management of surgical bleeding in adult and pediatric patients with congenital Factor XIII defi..."