| Health Net |
| Humate-P 500-1,000 Unit Kit (antihemophilic factor-vWF) |
| Drugs for the Blood : Drugs to Prevent Bleeding |
- Prior Authorization: Hemophilia A (Factor VIII):
Documented Diagnosis: Yes
Duration: 3 Month(s)
Reauthorization Required: Yes
- 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): Unspecified
Diagnosis Type(s): Mild
Diagnosis Treatments: Bleeding episodes
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
- Step Therapy: Hemophilia A (Factor VIII):
ST Single Generic
Von Willebrand Disease:
ST Generic and Brand
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