Prior Auth Required

14749 - [news release]. Genentech’s website. https://www.gene.com/media/press-releases/ /2018-10

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Service[news release]. Genentech’s website. https://www.gene.com/media/press-releases/ /2018-10
Procedure / Service Description

Updated Accessed - Clinical and Economic Review. April 16, 2018. 5 FDA Approves Genentech’s Hemlibra (Emicizumab-kxwh) for Hemophilia A Without Factor VIII Inhibitors 10/18 [news release]. Genentech’s website. https://www.gene.com/media/press-releases/14749/2018-10- 04/fda-approves-genentechs-hemlibra-emicizu. Accessed October 4, 2018. 6 HAVEN 3: Mahlangu J, Oldenburg J, Paz-Priel I, Negrier C, Niggli M, Mancuso ME, Schmitt C, Jiménez-Yuste V, 10/18

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.