skip to content
Primary navigation

Beqvez™

DrugsBeqvez™ (fidanacogene elaparvovec-dzkt) [Pfizer Inc.]

January 2025

Therapeutic area - Hemophilia Treatment

Approval criteria

  • Patient has a diagnosis of congenital hemophilia B (also known as Factor IX deficiency, Christmas disease) AND
  • Patient is 18 years of age or over AND
  • Patient has been screened for Factor IX inhibitor titers AND ONE of the following: (medical records required)
    • Patient tested negative for Factor IX inhibitor titers on the initial screening OR
    • BOTH of the following:
      • Patient tested positive for Factor IX inhibitors on the initial screening AND
      • Patient tested negative for Factor IX inhibitors within 2 weeks of initial screening AND
  • ONE of the following: (medical records required)
    • Patient is on prophylactic therapy with a Factor IX agent (e.g., AlphaNine SD,Alprolix, BeneFIX, Idelvion, Ixinity, Mononine, Profilnine SD, Rebinyn, Rixubis) OR
    • Patient has current or historical life-threatening hemorrhage OR
    • Patient has had repeated, serious spontaneous bleeding episodes AND
  • Prescriber has evaluated the patient's liver function and determined the patient has adequate liver function to receive the requested agent based on the following assessments:
    • Liver enzyme testing (i.e., alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase [ALP], total bilirubin) AND
    • Hepatic ultrasound and elastography AND
    • If patient has sustained liver enzyme elevations and/or radiological liver abnormalities, the prescriber has considered consultation with a specialist (i.e., hepatologist) AND
  • Patient has NOT had any previous gene therapy (including requested agent)

Quantity limits

  • 1 kit and may not be renewed

Billing for Beqvez

Beqvez must be billed as a medical claim

Questions?

Provider Call Center 844-575-7887

back to top