Antihemophilia Factors
PDL Status Values
Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the
Non-Preferred Drugs in Select PDL Classes prior authorization criteria.
New drugs will be listed as N until reviewed by the P&T Committee and are subject to the
New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.
To request a Prior Authorization, please use this form.
| NDC | Brand Name | Generic Name | Form | Strength | PDL Status |
Rebate | Current Drug Use Criteria |
|---|---|---|---|---|---|---|---|
| 64193032501 | FEIBA | anti-inhibitor coagulant comp. | VIAL | 1,750 unit-3,250 unit | Y | ||
| 64193042502 | FEIBA | anti-inhibitor coagulant comp. | VIAL | 1,750 unit-3,250 unit | Y | ||
| 64193032601 | FEIBA | anti-inhibitor coagulant comp. | VIAL | 350 unit-650 unit | Y | ||
| 64193042602 | FEIBA | anti-inhibitor coagulant comp. | VIAL | 350 unit-650 unit | Y | ||
| 64193032401 | FEIBA | anti-inhibitor coagulant comp. | VIAL | 700 unit-1,300 unit | Y | ||
| 64193042402 | FEIBA | anti-inhibitor coagulant comp. | VIAL | 700 unit-1,300 unit | Y | ||
| 69911047602 | AFSTYLA | antihem.FVIII,sin-chn,B-dm tru | VIAL | 1,000 (+/-) unit range | Y | ||
| 69911048002 | AFSTYLA | antihem.FVIII,sin-chn,B-dm tru | VIAL | 1,500 (+/-) unit range | Y | ||
| 69911049001 | AFSTYLA | antihem.FVIII,sin-chn,B-dm tru | VIAL | 1,500 (+/-) unit range | Y | ||
| 69911047702 | AFSTYLA | antihem.FVIII,sin-chn,B-dm tru | VIAL | 2,000 (+/-) unit range | Y | ||
| 69911048102 | AFSTYLA | antihem.FVIII,sin-chn,B-dm tru | VIAL | 2,500 (+/-) unit range | Y | ||
| 69911049101 | AFSTYLA | antihem.FVIII,sin-chn,B-dm tru | VIAL | 2,500 (+/-) unit range | Y | ||
| 69911047402 | AFSTYLA | antihem.FVIII,sin-chn,B-dm tru | VIAL | 250 (+/-) unit range | Y | ||
| 69911047802 | AFSTYLA | antihem.FVIII,sin-chn,B-dm tru | VIAL | 3,000 (+/-) unit range | Y | ||
| 69911047502 | AFSTYLA | antihem.FVIII,sin-chn,B-dm tru | VIAL | 500 (+/-) unit range | Y | ||
| 00944462401 | ADYNOVATE | antihemo.FVIII,full length peg | VIAL | 1,000 (+/-) unit range | Y | ||
| 00944462402 | ADYNOVATE | antihemo.FVIII,full length peg | VIAL | 1,000 (+/-) unit range | Y | ||
| 00944462701 | ADYNOVATE | antihemo.FVIII,full length peg | VIAL | 1,500 (+/-) unit range | Y | ||
| 00944462702 | ADYNOVATE | antihemo.FVIII,full length peg | VIAL | 1,500 (+/-) unit range | Y | ||
| 00944462501 | ADYNOVATE | antihemo.FVIII,full length peg | VIAL | 2,000 (+/-) unit range | Y | ||
| 00944462502 | ADYNOVATE | antihemo.FVIII,full length peg | VIAL | 2,000 (+/-) unit range | Y | ||
| 00944462201 | ADYNOVATE | antihemo.FVIII,full length peg | VIAL | 250 (+/-) unit range | Y | ||
| 00944462202 | ADYNOVATE | antihemo.FVIII,full length peg | VIAL | 250 (+/-) unit range | Y | ||
| 00944462801 | ADYNOVATE | antihemo.FVIII,full length peg | VIAL | 3,000 (+/-) unit range | Y | ||
| 00944462802 | ADYNOVATE | antihemo.FVIII,full length peg | VIAL | 3,000 (+/-) unit range | Y | ||
| 00944462301 | ADYNOVATE | antihemo.FVIII,full length peg | VIAL | 500 (+/-) unit range | Y | ||
| 00944462302 | ADYNOVATE | antihemo.FVIII,full length peg | VIAL | 500 (+/-) unit range | Y | ||
| 00944462601 | ADYNOVATE | antihemo.FVIII,full length peg | VIAL | 750 (+/-) unit range | Y | ||
| 00944462602 | ADYNOVATE | antihemo.FVIII,full length peg | VIAL | 750 (+/-) unit range | Y | ||
| 71104048608 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 1,000 unit | Y | ||
| 71104080401 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 1,000 unit | Y | ||
| 71104048708 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 1,500 unit | Y | ||
| 71104080501 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 1,500 unit | Y | ||
| 71104048808 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 2,000 unit | Y | ||
| 71104080601 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 2,000 unit | Y | ||
| 71104048308 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 250 unit | Y | ||
| 71104080101 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 250 unit | Y | ||
| 71104048908 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 3,000 unit | Y | ||
| 71104080701 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 3,000 unit | Y | ||
| 71104049008 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 4,000 unit | Y | ||
| 71104080801 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 4,000 unit | Y | ||
| 71104049108 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 5,000 unit | Y | ||
| 71104080901 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 5,000 unit | Y | ||
| 71104048408 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 500 unit | Y | ||
| 71104080201 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 500 unit | Y | ||
| 71104049208 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 6,000 unit | Y | ||
| 71104081001 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 6,000 unit | Y | ||
| 71104048508 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 750 unit | Y | ||
| 71104080301 | ELOCTATE | antihemoph.FVIII rec,Fc fusion | VIAL | 750 unit | Y | ||
| 00169781001 | NOVOEIGHT | antihemoph.FVIII,B-dom truncat | VIAL | 1,000 (+/-) unit range | Y | ||
| 00169781501 | NOVOEIGHT | antihemoph.FVIII,B-dom truncat | VIAL | 1,500 (+/-) unit range | Y | ||
| 00169782001 | NOVOEIGHT | antihemoph.FVIII,B-dom truncat | VIAL | 2,000 (+/-) unit range | Y | ||
| 00169782501 | NOVOEIGHT | antihemoph.FVIII,B-dom truncat | VIAL | 250 (+/-) unit range | Y | ||
| 00169783001 | NOVOEIGHT | antihemoph.FVIII,B-dom truncat | VIAL | 3,000 (+/-) unit range | Y | ||
| 00169785001 | NOVOEIGHT | antihemoph.FVIII,B-dom truncat | VIAL | 500 (+/-) unit range | Y | ||
| 58394002403 | XYNTHA SOLOFUSE | antihemoph.FVIII,B-domain del | SYRINGE | 1,000 (+/-) unit range | Y | ||
| 58394002503 | XYNTHA SOLOFUSE | antihemoph.FVIII,B-domain del | SYRINGE | 2,000 (+/-) unit range | Y | ||
| 58394002203 | XYNTHA SOLOFUSE | antihemoph.FVIII,B-domain del | SYRINGE | 250 (+/-) unit range | Y | ||
| 58394001603 | XYNTHA SOLOFUSE | antihemoph.FVIII,B-domain del | SYRINGE | 3,000 (+/-) unit range | Y | ||
| 58394002303 | XYNTHA SOLOFUSE | antihemoph.FVIII,B-domain del | SYRINGE | 500 (+/-) unit range | Y | ||
| 58394001401 | XYNTHA | antihemoph.FVIII,B-domain del | VIAL | 1,000 (+/-) unit range | Y | ||
| 58394001501 | XYNTHA | antihemoph.FVIII,B-domain del | VIAL | 2,000 (+/-) unit range | Y | ||
| 58394011501 | XYNTHA | antihemoph.FVIII,B-domain del | VIAL | 2,000 (+/-) unit range | Y | ||
| 58394001201 | XYNTHA | antihemoph.FVIII,B-domain del | VIAL | 250 (+/-) unit range | Y | ||
| 58394001301 | XYNTHA | antihemoph.FVIII,B-domain del | VIAL | 500 (+/-) unit range | Y | ||
| 68982014301 | NUWIQ | antihemoph.FVIII,HEK B-delete | VIAL | 1,000 (+/-) unit range | Y | ||
| 68982014401 | NUWIQ | antihemoph.FVIII,HEK B-delete | VIAL | 1,000 (+/-) unit range | Y | ||
| 68982015301 | NUWIQ | antihemoph.FVIII,HEK B-delete | VIAL | 1,500 (+/-) unit range | Y | ||
| 68982015401 | NUWIQ | antihemoph.FVIII,HEK B-delete | VIAL | 1,500 (+/-) unit range | Y | ||
| 68982014501 | NUWIQ | antihemoph.FVIII,HEK B-delete | VIAL | 2,000 (+/-) unit range | Y | ||
| 68982014601 | NUWIQ | antihemoph.FVIII,HEK B-delete | VIAL | 2,000 (+/-) unit range | Y | ||
| 68982014701 | NUWIQ | antihemoph.FVIII,HEK B-delete | VIAL | 2,500 (+/-) unit range | Y | ||
| 68982014801 | NUWIQ | antihemoph.FVIII,HEK B-delete | VIAL | 2,500 (+/-) unit range | Y | ||
| 68982013901 | NUWIQ | antihemoph.FVIII,HEK B-delete | VIAL | 250 (+/-) unit range | Y | ||
| 68982014001 | NUWIQ | antihemoph.FVIII,HEK B-delete | VIAL | 250 (+/-) unit range | Y | ||
| 68982014901 | NUWIQ | antihemoph.FVIII,HEK B-delete | VIAL | 3,000 (+/-) unit range | Y | ||
| 68982015001 | NUWIQ | antihemoph.FVIII,HEK B-delete | VIAL | 3,000 (+/-) unit range | Y | ||
| 68982015101 | NUWIQ | antihemoph.FVIII,HEK B-delete | VIAL | 4,000 (+/-) unit range | Y | ||
| 68982015201 | NUWIQ | antihemoph.FVIII,HEK B-delete | VIAL | 4,000 (+/-) unit range | Y | ||
| 68982014101 | NUWIQ | antihemoph.FVIII,HEK B-delete | VIAL | 500 (+/-) unit range | Y | ||
| 68982014201 | NUWIQ | antihemoph.FVIII,HEK B-delete | VIAL | 500 (+/-) unit range | Y | ||
| 00944305302 | ADVATE | antihemophil.FVIII,full length | VIAL | 1,000 (+/-) unit range | Y | ||
| 00944305303 | ADVATE | antihemophil.FVIII,full length | VIAL | 1,000 (+/-) unit range | Y | ||
| 00944305304 | ADVATE | antihemophil.FVIII,full length | VIAL | 1,000 (+/-) unit range | Y | ||
| 00026382425 | KOVALTRY | antihemophil.FVIII,full length | VIAL | 1,000 (+/-) unit range | Y | ||
| 00026482401 | KOVALTRY | antihemophil.FVIII,full length | VIAL | 1,000 (+/-) unit range | Y | ||
| 00944305402 | ADVATE | antihemophil.FVIII,full length | VIAL | 1,500 (+/-) unit range | Y | ||
| 00944305403 | ADVATE | antihemophil.FVIII,full length | VIAL | 1,500 (+/-) unit range | Y | ||
| 00944305404 | ADVATE | antihemophil.FVIII,full length | VIAL | 1,500 (+/-) unit range | Y | ||
| 00944304510 | ADVATE | antihemophil.FVIII,full length | VIAL | 2,000 (+/-) unit range | Y | ||
| 00944304511 | ADVATE | antihemophil.FVIII,full length | VIAL | 2,000 (+/-) unit range | Y | ||
| 00944304512 | ADVATE | antihemophil.FVIII,full length | VIAL | 2,000 (+/-) unit range | Y | ||
| 00026382650 | KOVALTRY | antihemophil.FVIII,full length | VIAL | 2,000 (+/-) unit range | Y | ||
| 00026482601 | KOVALTRY | antihemophil.FVIII,full length | VIAL | 2,000 (+/-) unit range | Y | ||
| 00944305102 | ADVATE | antihemophil.FVIII,full length | VIAL | 250 (+/-) unit range | Y | ||
| 00944305103 | ADVATE | antihemophil.FVIII,full length | VIAL | 250 (+/-) unit range | Y | ||
| 00944305104 | ADVATE | antihemophil.FVIII,full length | VIAL | 250 (+/-) unit range | Y | ||
| 00026382125 | KOVALTRY | antihemophil.FVIII,full length | VIAL | 250 (+/-) unit range | Y | ||
| 00026482101 | KOVALTRY | antihemophil.FVIII,full length | VIAL | 250 (+/-) unit range | Y | ||
| 00944304610 | ADVATE | antihemophil.FVIII,full length | VIAL | 3,000 (+/-) unit range | Y | ||
| 00944304611 | ADVATE | antihemophil.FVIII,full length | VIAL | 3,000 (+/-) unit range | Y | ||
| 00026382850 | KOVALTRY | antihemophil.FVIII,full length | VIAL | 3,000 (+/-) unit range | Y | ||
| 00026482801 | KOVALTRY | antihemophil.FVIII,full length | VIAL | 3,000 (+/-) unit range | Y | ||
| 00944304710 | ADVATE | antihemophil.FVIII,full length | VIAL | 4,000 (+/-) unit | Y | ||
| 00944305202 | ADVATE | antihemophil.FVIII,full length | VIAL | 500 (+/-) unit range | Y | ||
| 00944305203 | ADVATE | antihemophil.FVIII,full length | VIAL | 500 (+/-) unit range | Y | ||
| 00944305204 | ADVATE | antihemophil.FVIII,full length | VIAL | 500 (+/-) unit range | Y | ||
| 00026382225 | KOVALTRY | antihemophil.FVIII,full length | VIAL | 500 (+/-) unit range | Y | ||
| 00026482201 | KOVALTRY | antihemophil.FVIII,full length | VIAL | 500 (+/-) unit range | Y | ||
| 00026067050 | KOGENATE | antihemophilic factor, hum rec | KIT | 1,000 (+/-) unit range | Y | ||
| 00026067020 | KOGENATE | antihemophilic factor, hum rec | KIT | 250 (+/-) unit range | Y | ||
| 00026067030 | KOGENATE | antihemophilic factor, hum rec | KIT | 500 (+/-) unit range | Y | ||
| 00944283301 | RECOMBINATE | antihemophilic factor, hum rec | VIAL | 1,000 (+/-) unit range | Y | ||
| 00944284310 | RECOMBINATE | antihemophilic factor, hum rec | VIAL | 1,000 (+/-) unit range | Y | ||
| 00944284410 | RECOMBINATE | antihemophilic factor, hum rec | VIAL | 1,500 (+/-) unit range | Y | ||
| 00944283501 | RECOMBINATE | antihemophilic factor, hum rec | VIAL | 2,000 (+/-) unit range | Y | ||
| 00944284510 | RECOMBINATE | antihemophilic factor, hum rec | VIAL | 2,000 (+/-) unit range | Y | ||
| 00053811001 | BIOCLATE | antihemophilic factor, hum rec | VIAL | 250 (+/-) unit range | Y | ||
| 00944283101 | RECOMBINATE | antihemophilic factor, hum rec | VIAL | 250 (+/-) unit range | Y | ||
| 00944284110 | RECOMBINATE | antihemophilic factor, hum rec | VIAL | 250 (+/-) unit range | Y | ||
| 00944283201 | RECOMBINATE | antihemophilic factor, hum rec | VIAL | 500 (+/-) unit range | Y | ||
| 00944284210 | RECOMBINATE | antihemophilic factor, hum rec | VIAL | 500 (+/-) unit range | Y | ||
| 00053765601 | MONOCLATE-P | antihemophilic factor, human | KIT | 250 (+/-) unit range | Y | ||
| 00053765602 | MONOCLATE-P | antihemophilic factor, human | KIT | 500 (+/-) unit range | Y | ||
| 76125067351 | KOATE | antihemophilic factor, human | VIAL | 1,000 (+/-) unit range | Y | ||
| 76125067810 | KOATE | antihemophilic factor, human | VIAL | 1,000 (+/-) unit range | Y | ||
| 76125067912 | KOATE | antihemophilic factor, human | VIAL | 1,000 (+/-) unit range | Y | ||
| 00944394602 | HEMOFIL M | antihemophilic factor, human | VIAL | 1,501 unit-2,000 unit | Y | ||
| 00944394701 | HEMOFIL M | antihemophilic factor, human | VIAL | 1,501 unit-2,000 unit | Y | ||
| 00944394002 | HEMOFIL M | antihemophilic factor, human | VIAL | 220 unit-400 unit | Y | ||
| 00944394101 | HEMOFIL M | antihemophilic factor, human | VIAL | 220 unit-400 unit | Y | ||
| 76125025221 | KOATE | antihemophilic factor, human | VIAL | 250 (+/-) unit range | Y | ||
| 76125025725 | KOATE | antihemophilic factor, human | VIAL | 250 (+/-) unit range | Y | ||
| 76125025902 | KOATE | antihemophilic factor, human | VIAL | 250 (+/-) unit range | Y | ||
| 00944394202 | HEMOFIL M | antihemophilic factor, human | VIAL | 401 unit-800 unit | Y | ||
| 00944394301 | HEMOFIL M | antihemophilic factor, human | VIAL | 401 unit-800 unit | Y | ||
| 76125066350 | KOATE | antihemophilic factor, human | VIAL | 500 (+/-) unit range | Y | ||
| 76125066502 | KOATE | antihemophilic factor, human | VIAL | 500 (+/-) unit range | Y | ||
| 76125066931 | KOATE | antihemophilic factor, human | VIAL | 500 (+/-) unit range | Y | ||
| 00944394402 | HEMOFIL M | antihemophilic factor, human | VIAL | 801 unit-1,500 unit | Y | ||
| 00944394501 | HEMOFIL M | antihemophilic factor, human | VIAL | 801 unit-1,500 unit | Y | ||
| 68516460702 | ALPHANATE | antihemophilic factor/VWF | VIAL | 1,000 (400 VWF) unit/10 mL | Y | ||
| 68516461802 | ALPHANATE | antihemophilic factor/VWF | VIAL | 1,000 (400 VWF) unit/10 mL | Y | ||
| 68982018202 | WILATE | antihemophilic factor/VWF | VIAL | 1,000 unit-1,000 unit | Y | ||
| 63833061702 | HUMATE-P | antihemophilic factor/VWF | VIAL | 1,000 unit-2,400 unit | Y | ||
| 63833062701 | HUMATE-P | antihemophilic factor/VWF | VIAL | 1,000 unit-2,400 unit | Y | ||
| 68516460802 | ALPHANATE | antihemophilic factor/VWF | VIAL | 1,500 (600 VWF) unit/10 mL | Y | ||
| 68516461902 | ALPHANATE | antihemophilic factor/VWF | VIAL | 1,500 (600 VWF) unit/10 mL | Y | ||
| 68516461002 | ALPHANATE | antihemophilic factor/VWF | VIAL | 2,000 (800 VWF) unit/10 mL | Y | ||
| 68516462002 | ALPHANATE | antihemophilic factor/VWF | VIAL | 2,000 (800 VWF) unit/10 mL | Y | ||
| 68516460501 | ALPHANATE | antihemophilic factor/VWF | VIAL | 250 (100 VWF) unit/5 mL | Y | ||
| 68516461601 | ALPHANATE | antihemophilic factor/VWF | VIAL | 250 (100 VWF) unit/5 mL | Y | ||
| 63833061502 | HUMATE-P | antihemophilic factor/VWF | VIAL | 250 unit-600 unit | Y | ||
| 63833062501 | HUMATE-P | antihemophilic factor/VWF | VIAL | 250 unit-600 unit | Y | ||
| 68516460601 | ALPHANATE | antihemophilic factor/VWF | VIAL | 500 (200 VWF) unit/5 mL | Y | ||
| 68516461701 | ALPHANATE | antihemophilic factor/VWF | VIAL | 500 (200 VWF) unit/5 mL | Y | ||
| 63833061602 | HUMATE-P | antihemophilic factor/VWF | VIAL | 500 unit-1,200 unit | Y | ||
| 63833062601 | HUMATE-P | antihemophilic factor/VWF | VIAL | 500 unit-1,200 unit | Y | ||
| 68982018201 | WILATE | antihemophilic factor/VWF | VIAL | 500 unit-500 unit | Y | ||
| 00944500101 | OBIZUR | antihemophilic FVIII,rec porc | VIAL | 500 (+/-) unit range | Y | ||
| 00169720101 | NOVOSEVEN RT | coagulation factor VIIa,recomb | VIAL | 1 mg (1,000 mcg) | Y | ||
| 00169721111 | NOVOSEVEN RT | coagulation factor VIIa,recomb | VIAL | 1 mg (1,000 mcg) | Y | ||
| 00169720201 | NOVOSEVEN RT | coagulation factor VIIa,recomb | VIAL | 2 mg (2,000 mcg) | Y | ||
| 00169721211 | NOVOSEVEN RT | coagulation factor VIIa,recomb | VIAL | 2 mg (2,000 mcg) | Y | ||
| 00169720501 | NOVOSEVEN RT | coagulation factor VIIa,recomb | VIAL | 5 mg (5,000 mcg) | Y | ||
| 00169721511 | NOVOSEVEN RT | coagulation factor VIIa,recomb | VIAL | 5 mg (5,000 mcg) | Y | ||
| 00169720801 | NOVOSEVEN RT | coagulation factor VIIa,recomb | VIAL | 8 mg (8,000 mcg) | Y | ||
| 00169721811 | NOVOSEVEN RT | coagulation factor VIIa,recomb | VIAL | 8 mg (8,000 mcg) | Y | ||
| 71127100001 | SEVENFACT | coagulation VIIa,recomb-jncw | VIAL | 1 mg (1,000 mcg) | Y | ||
| 71127110001 | SEVENFACT | coagulation VIIa,recomb-jncw | VIAL | 1 mg (1,000 mcg) | Y | ||
| 71127200001 | SEVENFACT | coagulation VIIa,recomb-jncw | VIAL | 2 mg (2,000 mcg) | Y | ||
| 71127210001 | SEVENFACT | coagulation VIIa,recomb-jncw | VIAL | 2 mg (2,000 mcg) | Y | ||
| 71127500001 | SEVENFACT | coagulation VIIa,recomb-jncw | VIAL | 5 mg (5,000 mcg) | Y | ||
| 71127510001 | SEVENFACT | coagulation VIIa,recomb-jncw | VIAL | 5 mg (5,000 mcg) | Y | ||
| 00026394425 | JIVI | FVIII rec,B-dom delet peg-aucl | VIAL | 1,000 (+/-) unit range | Y | ||
| 00026494401 | JIVI | FVIII rec,B-dom delet peg-aucl | VIAL | 1,000 (+/-) unit range | Y | ||
| 00026394625 | JIVI | FVIII rec,B-dom delet peg-aucl | VIAL | 2,000 (+/-) unit range | Y | ||
| 00026494601 | JIVI | FVIII rec,B-dom delet peg-aucl | VIAL | 2,000 (+/-) unit range | Y | ||
| 00026394825 | JIVI | FVIII rec,B-dom delet peg-aucl | VIAL | 3,000 (+/-) unit range | Y | ||
| 00026494801 | JIVI | FVIII rec,B-dom delet peg-aucl | VIAL | 3,000 (+/-) unit range | Y | ||
| 00026395050 | JIVI | FVIII rec,B-dom delet peg-aucl | VIAL | 4,000 (+/-) unit range | Y | ||
| 00026395099 | JIVI | FVIII rec,B-dom delet peg-aucl | VIAL | 4,000 (+/-) unit range | Y | ||
| 00026495001 | JIVI | FVIII rec,B-dom delet peg-aucl | VIAL | 4,000 (+/-) unit range | Y | ||
| 00026495099 | JIVI | FVIII rec,B-dom delet peg-aucl | VIAL | 4,000 (+/-) unit range | Y | ||
| 00026394225 | JIVI | FVIII rec,B-dom delet peg-aucl | VIAL | 500 (+/-) unit range | Y | ||
| 00026494201 | JIVI | FVIII rec,B-dom delet peg-aucl | VIAL | 500 (+/-) unit range | Y | ||
| 00169810001 | ESPEROCT | FVIII rec,B-dom trunc peg-exei | VIAL | 1,000 (+/-) unit range | Y | ||
| 00169810111 | ESPEROCT | FVIII rec,B-dom trunc peg-exei | VIAL | 1,000 (+/-) unit range | Y | ||
| 00169815001 | ESPEROCT | FVIII rec,B-dom trunc peg-exei | VIAL | 1,500 (+/-) unit range | Y | ||
| 00169815111 | ESPEROCT | FVIII rec,B-dom trunc peg-exei | VIAL | 1,500 (+/-) unit range | Y | ||
| 00169820001 | ESPEROCT | FVIII rec,B-dom trunc peg-exei | VIAL | 2,000 (+/-) unit range | Y | ||
| 00169820111 | ESPEROCT | FVIII rec,B-dom trunc peg-exei | VIAL | 2,000 (+/-) unit range | Y | ||
| 00169830001 | ESPEROCT | FVIII rec,B-dom trunc peg-exei | VIAL | 3,000 (+/-) unit range | Y | ||
| 00169830111 | ESPEROCT | FVIII rec,B-dom trunc peg-exei | VIAL | 3,000 (+/-) unit range | Y | ||
| 00169840001 | ESPEROCT | FVIII rec,B-dom trunc peg-exei | VIAL | 4,000 (+/-) unit range | Y | ||
| 00169840111 | ESPEROCT | FVIII rec,B-dom trunc peg-exei | VIAL | 4,000 (+/-) unit range | Y | ||
| 00169850001 | ESPEROCT | FVIII rec,B-dom trunc peg-exei | VIAL | 500 (+/-) unit range | Y | ||
| 00169850111 | ESPEROCT | FVIII rec,B-dom trunc peg-exei | VIAL | 500 (+/-) unit range | Y | ||
| 71104098101 | ALTUVIIIO | FVIII rec,Fc-VWF-XTEN,BDD-ehtl | VIAL | 1,000 (+/-) unit range | Y | ||
| 71104098808 | ALTUVIIIO | FVIII rec,Fc-VWF-XTEN,BDD-ehtl | VIAL | 1,000 (+/-) unit range | Y | ||
| 71104098201 | ALTUVIIIO | FVIII rec,Fc-VWF-XTEN,BDD-ehtl | VIAL | 2,000 (+/-) unit range | Y | ||
| 71104098908 | ALTUVIIIO | FVIII rec,Fc-VWF-XTEN,BDD-ehtl | VIAL | 2,000 (+/-) unit range | Y | ||
| 71104097801 | ALTUVIIIO | FVIII rec,Fc-VWF-XTEN,BDD-ehtl | VIAL | 250 (+/-) unit range | Y | ||
| 71104098508 | ALTUVIIIO | FVIII rec,Fc-VWF-XTEN,BDD-ehtl | VIAL | 250 (+/-) unit range | Y | ||
| 71104098301 | ALTUVIIIO | FVIII rec,Fc-VWF-XTEN,BDD-ehtl | VIAL | 3,000 (+/-) unit range | Y | ||
| 71104099008 | ALTUVIIIO | FVIII rec,Fc-VWF-XTEN,BDD-ehtl | VIAL | 3,000 (+/-) unit range | Y | ||
| 71104098401 | ALTUVIIIO | FVIII rec,Fc-VWF-XTEN,BDD-ehtl | VIAL | 4,000 (+/-) unit range | Y | ||
| 71104099108 | ALTUVIIIO | FVIII rec,Fc-VWF-XTEN,BDD-ehtl | VIAL | 4,000 (+/-) unit range | Y | ||
| 71104097901 | ALTUVIIIO | FVIII rec,Fc-VWF-XTEN,BDD-ehtl | VIAL | 500 (+/-) unit range | Y | ||
| 71104098608 | ALTUVIIIO | FVIII rec,Fc-VWF-XTEN,BDD-ehtl | VIAL | 500 (+/-) unit range | Y | ||
| 71104098001 | ALTUVIIIO | FVIII rec,Fc-VWF-XTEN,BDD-ehtl | VIAL | 750 (+/-) unit range | Y | ||
| 71104098008 | ALTUVIIIO | FVIII rec,Fc-VWF-XTEN,BDD-ehtl | VIAL | 750 (+/-) unit range | Y |