| Anthem Blue Cross (HMO, PPO, EPO) |
| Xpovio (60 MG Twice Weekly) (selinexor) |
| Drugs for Cancer : Drugs for Cancer |
- Quantity Limit: limit maximum 30 day(s) supply
- May be covered under Medical Benefit.
- Cystic Fibrosis (CF):
Age Requirement: >= 1
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: Unspecified
Documented Mutation in the CFTR Gene: Yes
Documented Homozygous F508del Mutation in the CFTR Gene: No
Pseudomonas Aeruginosa Culture Required: No
Baseline FEV1 Value (percent predicted): N/A
FEV1 ImprovementMaintenance for Reauthorization: No
Liver Function Test Required: No
- Prior Authorization: PA Required
- May process through Pharmacy or Medical benefit depending on Patient location;
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;
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