Health Net
Besremi (ropeginterferon alfa-2b-njft)
Drugs for Cancer : Drugs for Cancer
  • Prior Authorization: Polycythemia Vera (PV):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Step Therapy: Polycythemia Vera (PV):
    ST Single Generic

  • Polycythemia Vera (PV):
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): 1 of Hematologist;Oncologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)