Health Net
Esperoct (FVIII rec,B-dom trunc peg-exei)
Drugs for the Blood : Drugs to Prevent Bleeding
  • Prior Authorization: Hemophilia A (Factor VIII):
    Documented Diagnosis: Yes
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Hemophilia A (Factor VIII):
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Hematologist
    Reauthorization Required: Yes
    Duration of Reauthorization: <= 6 month(s)
    Dosing Limit(s): Variable
    Diagnosis Type(s): 1 of Mild;Severe
    Diagnosis Treatments: 1 of Bleeding episodes;Peri-procedural operative management;Routine propylaxis
    Treatment Center Required: No

  • Step Therapy: Hemophilia A (Factor VIII):
    ST Single Generic

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