Bleeding disorders, such as hemophilia, are chronic conditions. Bleeding can occur spontaneously or following trauma. That means patients need ready access to clotting factor and related products when bleeding occurs.

Many physicians prescribe clotting factor for patients to keep on hand in case of acute bleeding episodes. It is important that the amounts prescribed be appropriate to each patient’s condition and medical need. Blue Cross and Blue Shield of Texas (BCBSTX) recommends the Medical and Scientific Advisory Council Recommendation Concerning Prophylaxis as a helpful resource to manage your patients with bleeding disorders.

A physician should assess each patient’s clinical status before prescribing a refill of clotting factor or related products. The assessment should include documentation of:

• Number of hemarthoses and infusions since the last refill;
• Incidence of adverse events, emergency room visits and hospitalizations;
• Amount of clotting factor the patient currently has on hand; and
• Patient and family adherence to the medical treatment plan.

BCBSTX will review prescription data for clotting factor and related products. When we identify high utilization for a patient, we will send the physician a form to report key clinical information and the medical rationale for the prescribed dose.

To review a sample of the Hemophilia Therapy: Quantity vs. Time Documentation Form

When received, a Medical Director will review the completed forms. The Medical Director will call physicians with questions or concerns.
If you have any questions about this review program, please contact Dr. Allan Chernov at 972-766-1149 or by e-mail at allan_chernov@bcbstx.com.