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Medication Prior Authorization Form (recombinant coagulation Factor IX, FC Fusion protein fixed) Policy Number:1044Policy History Approve Date:12/11/2015Revise Dates:Next Review:12/11/2016Review Dates:Preauthorization
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Who needs recombinant coagulation factor ix?

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People with hemophilia B, a genetic disorder that affects the blood's ability to clot, may need recombinant coagulation factor IX.
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Recombinant coagulation factor IX can be used for both adults and children with hemophilia B.
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Individuals who experience frequent bleeding episodes or have severe forms of hemophilia B may require regular doses of recombinant coagulation factor IX.
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Recombinant coagulation factor IX is a medication used to treat and prevent bleeding episodes in patients with hemophilia B.
Medical professionals or healthcare facilities that administer or distribute recombinant coagulation factor IX are required to file relevant documentation.
The documentation for recombinant coagulation factor IX should include information on the patient receiving the medication, the dosage administered, and any relevant medical history.
The purpose of recombinant coagulation factor IX is to help control bleeding and prevent complications in patients with hemophilia B.
Information that must be reported includes the patient's name, date of birth, medical history, dosage of medication administered, and any adverse reactions experienced.
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