Sevenfact [coagulation factor VIIa (recombinant)-jncw]-NF
Indications for Prior Authorization
Sevenfact [coagulation factor VIIa (recombinant)-jncw]
-
For diagnosis of Hemophilia A or B with Inhibitors
Indicated for the treatment and control of bleeding episodes occurring in adults and adolescents (12 years of age and older) with hemophilia A or B with inhibitors.Limitation of Use: Sevenfact is not indicated for the treatment of patients with congenital Factor VII deficiency.
Criteria
Sevenfact
Non Formulary
Length of Approval: 12 Month(s)
- Requested drug is being used for a Food and Drug Administration (FDA)-approved indication AND
- Paid claims or submission of medical records (e.g., chart notes) confirming trial of or intolerance to Novoseven RT
P & T Revisions
2025-02-28, 2024-06-20, 2023-05-23, 2022-06-16, 2021-12-01, 2021-06-02
References
- Sevenfact Prescribing Information. Hema Biologics, Louisville, KY. November 2022.
Revision History
- 2025-02-28: Removal of ST criteria due to low utilization within 2024
- 2024-06-20: 2024 annual review: no changes.
- 2023-05-23: 2023 UM Annual Review. No criteria changes
- 2022-06-16: Annual review - no changes.
- 2021-12-01: Added NF section and diagnosis requirement to ST.
- 2021-06-02: New program.
HEALTHY LIVING