Anthem Blue Cross (HMO, PPO, EPO)
Scemblix (asciminib)
Drugs for Cancer : Drugs for Cancer
  • Available only through Specialty Pharmacy; Limited access;
    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;
  • PA Applies
  • Chronic Myelogenous Leukemia:
    Age Requirement: >= 18
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: No
    Duration of Reauthorization: N/A

  • Quantity Limit: 2 tablets per 1 day(s).
  • Prior Authorization: Chronic Myelogenous Leukemia:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 18