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The Policy VaultThe Policy Vault

Hemlibra (emicizumab-kxwh subcutaneous injection) — Cigna

Routine prophylaxis to prevent or reduce the frequency of bleeding episodes in patients with Hemophilia A without Factor VIII inhibitors

Initial criteria

  • The medication is prescribed by or in consultation with a hemophilia specialist

Reauthorization criteria

  • The medication is prescribed by or in consultation with a hemophilia specialist; AND
  • According to the prescriber, the patient experienced a beneficial response to therapy

Approval duration

12 months