Clotting Factors, Coagulant Blood Products, & Other Hemostatics – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers clotting factors, coagulant blood products and specified non‑factor hemostatic agents for routine prophylaxis, peri‑operative management, or treatment of bleeding in congenital and acquired bleeding disorders (examples: FVIII/FIX products, VWF products, FXIII agents, Alhemo, Hemlibra, Hympavzi, Qfitlia, Jivi), but lists Esperoct, Ixinity, and Rebinyn as not medically necessary and notes product‑specific limitations (e.g., FEIBA not for deficiency without inhibitors; Sevenfact not for congenital FVII deficiency). Coverage requires documentation of diagnosis, product‑specific age limits, inhibitor status (Bethesda assay) when applicable, prior treatment failure/hypersensitivity or mandated trials for some agents (notably Xyntha), self‑injectable non‑factor agents are generally covered under the pharmacy benefit unless the patient cannot self‑inject or is treated at a contracted hemophilia treatment center, and continuation requires evidence of clinical response and adherence to the member’s benefit plan.