| Health Net |
| Pegasys ProClick 180 Mcg/0.5 Ml Pnij (peginterferon alfa-2a) |
| Drugs for Infections : Drugs for Viral Infections |
- Hepatitis B Treatment:
Age Requirement: >= 3
Duration: 48 week(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): 1 of Gastroenterologist;Hepatologist;Infectious Disease Specialist
Reauthorization Required: Yes
Duration of Reauthorization: <= 48 week(s)
- Prior Authorization: Hepatitis B Treatment:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 3
Duration: 48 week(s)
Reauthorization Required: Yes
|