Sutter Health Plus
Exjade (deferasirox)
Drugs for Overdose or Poisoning : Drugs for Overdose or Poisoning
  • PA Applies
  • Prior Authorization: Cryopyrin-Associated Periodic Syndromes (CAPS):
    Duration: 12 Month(s)
    Reauthorization Required: Yes

    Recurrent Pericarditis :
    Documented Diagnosis: Yes
    Age Requirement: >= 12
    Duration: 12 Month(s)
    Reauthorization Required: Yes

  • Quantity Limit: 30 day supply per 1 fill(s).
  • ST_APPLIES
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