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


 

Last review date: May 1, 2014

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