| Anthem Blue Cross (HMO, PPO, EPO) |
| Profilnine (factor IX cplx(pcc)no4,3factor) |
| Drugs for the Blood : Drugs to Prevent Bleeding |
- Available only through Specialty Pharmacy; Limited access;
For FAX form click HERE
Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
Log in to Surescripts
Log in to CoverMyMeds; For details on drug coverage click HERE;
- Hemophilia B (Factor IX):
Duration: 1 year(s)
Documented Diagnosis: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Dosing Limit(s): N/A
Treatment Center Required: No
- Step Therapy: Hemophilia B (Factor IX):
ST Multiple Brands
- Prior Authorization: Hemophilia B (Factor IX):
Duration: 1 year(s)
- PA Applies
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