Health Net
Darzalex Faspro (daratumumab-hyaluronidase-fihj)
Drugs for Cancer : Drugs for Cancer
  • Prior Authorization: Multiple Myeloma:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Multiple Myeloma:
    Age Requirement: >= 18
    Duration: 6 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: Payer Specific
    ECOG Score Requirement in Policy: N/A
    ECOG status <=2: No
    Diagnosis Types: 1 of in combination with bortezomib and dexamethasone after at least one prior therapy;in combination with bortezomib, melphalan and prednisone in newly diagnosed disease ineligible for autologous stem cell transplant;in combination with lenalidomide and dexamethasone for the treatment multiple myeloma after at least one prior therapy. ;in combination with lenalidomide and dexamethasone in newly diagnosed disease ineligible for autologous stem cell transplant ;in combination with pomalidomide and dexamethasone for the treatment of multiple myeloma after at least two prior therapies including lenalidomide and a proteasome inhibitor.
    Concomitant Therapy Requirement: 1 of Bortezomib, melphalan, prednisone (VMP);in combination with bortezomib and dexamethasone;In combination with Bortezomib, Thalidomide, and Dexamethasone;in combination with carfilzomib and dexamethasone;in combination with lenalidomide and dexamethasone;in combination with pomalidomide and dexamethasone