Drugs for the Blood

BRAND NAME: Hemlibra

GENERIC NAME: 
emicizumab-kxwh No Generic Available
  Status Notes or Restrictions
Anthem Blue Cross (HMO, PPO, EPO) nonform.gif (625 bytes) NOTES_restrict.gif (377 bytes)
Cigna + Oscar approved.gif (510 bytes) NOTES_restrict.gif (377 bytes)
Health Net priorauth.gif (816 bytes) NOTES_restrict.gif (377 bytes)
Kaiser Foundation Health Plan Northern California preferred.gif (540 bytes) NOTES_restrict.gif (377 bytes)
Kaiser Foundation Health Plan Southern California preferred.gif (540 bytes) NOTES_restrict.gif (377 bytes)
Oscar approved.gif (510 bytes) NOTES_restrict.gif (377 bytes)
Sharp Health Plan notreimb.gif (645 bytes)  
Sutter Health Plus notlisted.gif (324 bytes)  
UnitedHealthcare priorauth.gif (816 bytes) NOTES_restrict.gif (377 bytes)
Western Health Advantage notreimb.gif (645 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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