Anthem Blue Cross (HMO, PPO, EPO) |
Fabrazyme (agalsidase beta) |
Drugs for Metabolic Disease : Drugs for Metabolic Disease |
- PA Applies
- Available only through Specialty Pharmacy;
For FAX form click HERE Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites: Log in to Surescripts Log in to CoverMyMeds; For details on drug coverage click HERE; Dosing Limit: 1 mg/kg every two weeks;
- Prior Authorization: Fabry's Disease:
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 1 year(s)
Reauthorization Required: Yes
- Fabry's Disease:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialty Pharmacy Provider(s): Accredo Health Group, Inc.;N/A
Reauthorization Required: Yes
Duration of Reauthorization: Unspecified
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