Kaiser Foundation Health Plan Northern 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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