Hympavzi (marstacimab-hncq) — CareFirst (Caremark)
Hemophilia A (congenital factor VIII deficiency) without factor VIII inhibitors
Preferred products
- Advate
- Adynovate
- Eloctate
- Alprolix
- Ixinity
- Rebinyn
Initial criteria
- Prescribed by or in consultation with a hematologist
- Member is 12 years of age or older
- Member is ≥ 35 kg
- Member must be using the requested medication for routine prophylaxis to prevent or reduce the frequency of bleeding episodes
- Member will not use the requested medication to treat breakthrough bleeding
- Member does not have a history of coronary artery disease, venous or arterial thrombosis or ischemic disease
- Member does not have unstable or abnormal hepatic, biliary, or renal function/disease
- Hympavzi will not be used in combination with Hemlibra
- Prophylactic use of factor VIII or factor IX products will be discontinued prior to starting therapy with the requested medication
- Member has not previously received treatment with a gene therapy product appropriate for the hemophilia type
Reauthorization criteria
- Member is experiencing benefit from therapy (e.g., reduced frequency or severity of bleeds)
- Member has no detectable or documented history of factor VIII or IX inhibitors
- Member is not using the requested medication in combination with factor VIII or IX products for prophylactic use
Approval duration
12 months