Anthem Blue Cross - 2014 to Present (HMO, PPO, EPO)
Xarelto Starter Pack (rivaroxaban)
Drugs for the Blood : Drugs to Prevent Blood Clots
  • Zero Copay;
  • Multiple Myeloma:
    Age Requirement: >= 18
    Duration: 12 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Hematologist;Oncologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Drug Policy Based On: 1 of FDA Approved Indications;NCCN Guidelines
    ECOG Score Requirement in Policy: N/A
    ECOG status <=2: No
    Diagnosis Types: 2 of in combination with bortezomib and dexamethasone for the treatment of multiple myeloma after at least 2 prior regimens, including bortezomib and an immunomodulatory agent;Multiple Myeloma
    Concomitant Therapy Requirement: in combination with bortezomib and dexamethasone

  • Zero Copay; $0 copay;
  • Prior Authorization: Documented Diagnosis: Yes