Qfitlia (fitusiran) — United Healthcare
Hemophilia A without inhibitors
Preferred products
- Hympavzi
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)
- One of the following: Based on clinical assessment, provider has determined patient is not an appropriate candidate for Hympavzi (document reason) OR Both of the following: patient is currently on Qfitlia therapy AND patient has not received a manufacturer supplied sample or any assistance from HemAssist or Sanofi Patient Support
Reauthorization criteria
- Documentation of positive clinical response to Qfitlia therapy
Approval duration
12 months