Wilate

This policy covers Wilate, a von Willebrand factor/Factor VIII concentrate, for treatment of von Willebrand disease (on‑demand, perioperative management, and routine prophylaxis) and for on‑demand treatment and routine prophylaxis of hemophilia A. Coverage is limited to VWD patients unresponsive, intolerant, or contraindicated to desmopressin (routine prophylaxis restricted to children ≥6 years and adults) and to adolescents/adults with hemophilia A; use must follow FDA labeling and authoritative dosing recommendations, with off‑label uses requiring support from HHS‑adopted compendia or two peer‑reviewed articles, while other indications are considered experimental/unproven. Coverage is also subject to the member’s benefit plan, applicable state regulations, and the policy’s evidence standards.

"Therapy is covered when proven effective for the relevant diagnosis or procedure."