Health Net |
Jivi (FVIII rec,B-dom delet peg-aucl) |
Drugs for the Blood : Drugs to Prevent Bleeding |
- Step Therapy: Hemophilia A (Factor VIII):
ST Single Generic
- Hemophilia A (Factor VIII):
Age Requirement: >= 12
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Hematologist
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
Dosing Limit(s): Variable
Diagnosis Type(s): 1 of Mild;Severe
Diagnosis Treatments: 1 of Bleeding episodes;Peri-procedural operative management;Routine propylaxis
Treatment Center Required: No
- Prior Authorization: Hemophilia A (Factor VIII):
Documented Diagnosis: Yes
Age Requirement: >= 12
Duration: 6 Month(s)
Reauthorization Required: Yes
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