UnitedHealthcare - 2014 to Present
Kitabis Pak (tobramycin with nebulizer)
Drugs for the Lungs : Drugs for Cystic Fibrosis
  • Crohn's Disease (CD):
    Age Requirement: >= 6
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified
    TB Test required: Yes

    Hidradenitis Suppurativa (HS):
    Age Requirement: >= 12
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialty Pharmacy Provider(s): CVS Specialty
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified

    Ulcerative Colitis (UC):
    Age Requirement: >= 5
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified
    TB Test required: Yes

  • Neutropenia:
    Duration: 1 year(s)
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Risk Factor for Developing Febrile Neutropenia (FN): 1 of Age greater than 65 years;Bone marrow involvement;Extensive prior chemotherapy/radiation therapy;Liver dysfunction;Open wounds;Poor performance status;Poor renal function;Pre-existing neutropenia
    Documented Diagnosis: Yes
    Criteria includes risk factor for developing FN: Yes