| Anthem Blue Cross (HMO, PPO, EPO) |
| Akynzeo (fosnetupitant-palonosetron) |
| Drugs for the Stomach : Drugs for Vomiting and Nausea |
- Chemo-induced Nausea and Vomiting (CINV):
Age Requirement: >= 18
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
NV associated with highly emetogenic cancer chemotherapy (HEC): Yes
NV associated with moderately emetogenic cancer chemotherapy (MEC): No
Concomitant therapy with Corticosteroid: No
Concomitant therapy with 5-HT3 Antagonist: Yes
- Quantity Limit: 5 vials per 30 day(s).
- Prior Authorization: Chemo-induced Nausea and Vomiting (CINV):
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 1 year(s)
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