Kaiser Foundation Health Plan Southern California
Onureg (azacitidine)
Drugs for Cancer : Drugs for Cancer
  • Prior Authorization: Acute Myeloid Leukemia:
    Documented Diagnosis: Yes
    Age Requirement: >= 18

  • Acute Myeloid Leukemia:
    Age Requirement: >= 18
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Hematologist;Oncologist
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Drug Policy Based On: Payer Specific
    Supporting Documentation Requirements: Documented rationale showing inability to use IV or SQ formulation
    Quantity Limit: N/A
    Diagnosis Types: Continued treatment of acute myeloid leukemia after first complete remission (CR) or complete remission with incomplete blood count recovery (CRi) following intensive induction chemotherapy and unable to complete intensive curative therapy
    Excludes Coverage in Maintenance Setting: No