UnitedHealthcare
Adynovate (antihemo.FVIII,full length peg)
Drugs for the Blood : Drugs to Prevent Bleeding
  • Step Therapy Applies
  • Prior Authorization: Hemophilia A (Factor VIII):
    Documented Diagnosis: Yes
    Age Requirement: >= 12
    Duration: 12 Month(s)
    Reauthorization Required: Yes

  • Hemophilia A (Factor VIII):
    Age Requirement: >= 12
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Dosing Limit(s): <= 70
    Diagnosis Type(s): Unspecified
    Treatment Center Required: No

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