| Health Net |
| NovoSeven RT (coagulation factor VIIa recomb) |
| Drugs for the Blood : Drugs to Prevent Bleeding |
- Prior Authorization: Hemophilia A or B with Inhibitor:
PA Applies
- Step Therapy: Hemophilia A or B with Inhibitor:
ST Single Brand
- Hemophilia A or B with Inhibitor:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
Dosing Limit(s): Unspecified
Treatment Center Required: No
Dosing Limits Exist: No
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