Skip to content
The Policy VaultThe Policy Vault

Hympavzi (marstacimab-hncq)Medica

Hemophilia A without Factor VIII inhibitors

Initial criteria

  • age ≥ 12 years
  • using Hympavzi for routine prophylaxis to prevent or reduce the frequency of bleeding episodes
  • has moderately severe to severe hemophilia A as evidenced by baseline Factor VIII level ≤ 2% (without Factor VIII replacement therapy)
  • EITHER (a) Factor VIII inhibitor titer testing performed within the past 30 days AND inhibitor titer < 1.0 Bethesda units/mL OR (b) has not received Factor VIII therapy in the past
  • prophylactic use of Factor VIII products will be discontinued (use for breakthrough bleeding allowed)
  • prescribed by or in consultation with a hemophilia specialist

Reauthorization criteria

  • using Hympavzi for routine prophylaxis to prevent or reduce the frequency of bleeding episodes
  • prophylactic use of Factor VIII products will not occur while receiving Hympavzi (use for breakthrough bleeding allowed)
  • prescribed by or in consultation with a hemophilia specialist
  • patient experienced a beneficial response to therapy (e.g., reduction in bleeding events, severity, or spontaneous bleeds)

Approval duration

1 year