Health Net |
Alphanate 375 (+/-) Unit Solr (antihemophilic factor) |
Drugs for the Blood : Drugs to Prevent Bleeding |
- Step Therapy: Hemophilia A (Factor VIII):
ST Single Generic
Von Willebrand Disease: ST Generic and Brand
- Hemophilia A (Factor VIII):
Duration: 3 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Hematologist
Reauthorization Required: Yes
Duration of Reauthorization: = 3 month(s)
Dosing Limit(s): <= 100
Diagnosis Type(s): Mild
Diagnosis Treatments: 1 of Bleeding episodes;Peri-procedural operative management
Treatment Center Required: No
Von Willebrand Disease: Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Dosing Limit(s): N/A
Treatment Center Required: No
Dosing Limits Exist: No
- Prior Authorization: Hemophilia A (Factor VIII):
Documented Diagnosis: Yes
Duration: 3 Month(s)
Reauthorization Required: Yes
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