In some cases, prior authorization for clotting factor merely requires the appropriate diagnosis code; however in other cases the criteria for factor and related therapies may be more complicated
Considering the high cost of recently approved HCV treatments, payers are beginning to place narrower criteria on these antiviral agents in particular
A thorough and complete claims submission increases the likelihood of approval, contingent upon inclusion of the following elements:
HCV genotype
Current detectable HCV RNA quantitative viral load
Liver fibrosis staging score
Baseline laboratory results (complete blood count [CBC], international normalized ratio [INR], hepatic function panel, and calculated glomerular filtration rate [GFR])