Drugs for the Nervous System
Drugs for Multiple Sclerosis

BRAND NAME: Rebif Titration Pack

GENERIC NAME: 
interferon beta-1a (albumin) No Generic Available
  Status Notes or Restrictions
Anthem Blue Cross (HMO, PPO, EPO) approved.gif (510 bytes) NOTES_restrict.gif (377 bytes)
Cigna + Oscar preferred.gif (540 bytes) NOTES_restrict.gif (377 bytes)
Health Net priorauth.gif (816 bytes) NOTES_restrict.gif (377 bytes)
Kaiser Foundation Health Plan Northern California approved.gif (510 bytes)  
Kaiser Foundation Health Plan Southern California approved.gif (510 bytes)  
Oscar approved.gif (510 bytes) NOTES_restrict.gif (377 bytes)
Sharp Health Plan notreimb.gif (645 bytes)  
Sutter Health Plus approved.gif (510 bytes) NOTES_restrict.gif (377 bytes)
UnitedHealthcare notreimb.gif (645 bytes)  
Western Health Advantage approved.gif (510 bytes) NOTES_restrict.gif (377 bytes)


preferred.gif (540 bytes)  Preferred

approved.gif (510 bytes)   Approved

priorauth.gif (816 bytes)  Prior Auth.
nonform.gif (625 bytes)    Non-Formulary notreimb.gif (645 bytes)   Not Reimbursed notlisted.gif (324 bytes)   Not Listed
nonform.gif (625 bytes)    Benefits/Policies generic.gif (400 bytes) Generic Available, Brand Listed for reference only. Brand may not be covered.

NOTES.gif (377 bytes)NOTES_restrict.gif (372 bytes)

 Notes or
Restrictions

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