Coagulation Factor IX (Alprolix)

Coagulation Factor IX (Alprolix®)

OFFICE ADMINISTRATION

Indications for Prior Authorization:

• Control and prevention of bleeding episodes in adults and children with hemophilia B

Patients must meet the following criteria for the indications above:

• Perioperative management or routine prophylaxis

This Medication is Not Approvable for the following condition(s):

• Any condition not listed above as an approved indication

Dosing:

• Dosing is individualized by type of bleed and circulating levels of factor
• Routine prophylaxis the recommended dose is 50 IU/kg once weekly or 100 IU/kg every 10 days

Approval:

One year