Kaiser Foundation Health Plan Southern California |
Empaveli (pegcetacoplan) |
Drugs for the Blood : Drugs for the Blood |
- Step Therapy Applies
- Paroxysmal Nocturnal Hemoglobinuria:
Age Requirement: >= 18
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): 1 of Hematologist;Oncologist
Reauthorization Required: No
Duration of Reauthorization: N/A
- Prior Authorization: Paroxysmal Nocturnal Hemoglobinuria:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
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