UnitedHealthcare |
Adynovate (antihemo.FVIII,full length peg) |
Drugs for the Blood : Drugs to Prevent Bleeding |
- Step Therapy Applies
- Prior Authorization: Hemophilia A (Factor VIII):
Documented Diagnosis: Yes
Age Requirement: >= 12
Duration: 12 Month(s)
Reauthorization Required: Yes
- Hemophilia A (Factor VIII):
Age Requirement: >= 12
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Dosing Limit(s): <= 70
Diagnosis Type(s): Unspecified
Treatment Center Required: No
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