Alhemo (concizumab-mtci) — United Healthcare
Hemophilia A without inhibitors
Initial criteria
- Diagnosis of hemophilia A
- Patient has not developed high-titer factor VIII inhibitors (< 5 Bethesda units [BU])
- age ≥ 12 years
- Prescribed for the prevention of bleeding episodes (routine prophylaxis)
Reauthorization criteria
- Documentation of positive clinical response to Alhemo therapy
Approval duration
12 months