| Anthem Blue Cross (HMO, PPO, EPO) |
| Lynparza (Cap) (olaparib) |
| Drugs for Cancer : Drugs for Cancer |
- PA Applies
- Prior Authorization: Ovarian Cancer:
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 1 year(s)
- Quantity Limit: 16 capsules per 1 day(s).
- Available only through Specialty Pharmacy;
For FAX form click HERE
Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
Log in to Surescripts
Log in to CoverMyMeds; For details on drug coverage click HERE;
- Ovarian Cancer:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: No
Duration of Reauthorization: N/A
Drug Policy Based On: 1 of NCCN Guidelines;Payer Specific
Concomitant Therapy Requirement: bevacizumab (Avastin)
Diagnosis Types: 4 of advanced ovarian cancer;deleterious or suspected deleterious germline and/or somatic BRCA mutation;epithelial ovarian, fallopian tube, or primary peritoneal cancer;maintenance treatment after a complete or partial response to platinum-based chemotherapy;Patients who have been treated with three or more prior lines of chemotherapy
Supporting Documentation Requirements: 2 of BRCA mutation as detected by an approved FDA laboratory test;Homologous recombination deficiency (HRD) testing
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