Health Net
Prevymis (letermovir)
Drugs for Infections : Drugs for Viral Infections
  • Step Therapy Applies
  • Cytomegalovirus (CMV):
    Age Requirement: >= 18
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): 1 of Hematologist;Infectious Disease Specialist;Oncologist;Transplant Specialist
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified

  • Prior Authorization: Cytomegalovirus (CMV):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 18
    Reauthorization Required: Yes

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