- Acute Myeloid Leukemia:
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): 1 of Hematologist;Oncologist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Drug Policy Based On: 1 of FDA Approved Indications;NCCN Guidelines
Quantity Limit: N/A
Criteria for Reauthorization: No evidence of disease progression or unacceptable toxicity
Diagnosis Types: newly-diagnosed t-AML or AML-MRC
Excludes Coverage in Maintenance Setting: No
- Prior Authorization: Acute Myeloid Leukemia:
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
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