Hemophilia Drug Prior Authorization

To contribute to improved transparency around clinical management, Magellan Rx's Hemophilia Management services will be used to perform utilization management and oversight of specialty pharmacy dispensing as part of this program.

For groups that have their pharmacy benefits carved in and participate in utilization management, Magellan Rx will perform the prior authorization (PA) drug reviews. The PA reviews will ensure that optimal dosing and products are being prescribed. 

Please review the hemophilia drug policies posted on this site.

How to Submit a Prior Authorization

Prescribers may submit a prior authorization request online through the website listed on the back of the patient’s ID card or by calling Magellan Rx at 1-800-424-8270.

Specialty pharmacies seeking initial prior authorization on behalf of the prescriber should complete the Hemophilia Prior Authorization Form or call MagellanRx at 1-800-424-8270.

After initial approval of a hemophilia drug PA, specialty pharmacies dispensing the hemophilia drugs will also be required to complete a Hemophilia Case Review Form to obtain a dose authorization from Magellan Rx prior to each dispensing of the drug. Through this additional dose authorization, Magellan Rx will ensure that appropriate assay management, inventory management, and patient engagement are being provided.

Policy # Policy Title Print View
PH-133 Hemophilia Case Review Form