Western Health Advantage
deferasirox (deferasirox)
Drugs for Overdose or Poisoning : Drugs for Overdose or Poisoning
  • Step Therapy: ST_APPLIES
  • Ankylosing Spondylitis (AS), Crohn's Disease (CD), Juvenile Idiopathic Arthritis, Psoriatic Arthritis (PsA), Rheumatoid Arthritis (RA):
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 24 month(s)
    TB Test required: No

    Hidradenitis Suppurativa (HS):
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 24 month(s)

    Psoriasis (PsO):
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 24 month(s)
    TB Test required: No
    History of Plaque Psoriasis: N/A
    Overall % of Body Surface For Initiation: N/A
    Overall % of Body Surface For Initiation With Sensitive Areas: N/A
    Psoriasis Classification: Moderate-Severe
    Sensitive Area BSA Percent override: No

    Ulcerative Colitis (UC):
    Duration: 12 week(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 24 month(s)
    TB Test required: No

    Uveitis:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialty Pharmacy Provider(s): 1 of AllCare Plus Pharmacy;BriovaRx
    Reauthorization Required: No
    Duration of Reauthorization: N/A

  • ST Required
  • Step Therapy: Immune Thrombocytopenic Purpura (ITP):
    ST Single Generic