Cigna + Oscar
Venclexta Starting Pack (venetoclax)
Drugs for Cancer : Drugs for Cancer
  • Amyotrophic Lateral Sclerosis (ALS):
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

  • Asthma (injectable):
    Age Requirement: >= 6
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified
    # of exacerbations in prior year: >= 2
    History of corticosteroid use: >= 3 months
    Additional controller failure requirement: 1
    EOS levels required at baseline (cellsmcl): >= 150
    Diagnosis Type: Moderate to Severe
    Evidence of Asthma Indicators: 2 of FEV1 <= 80% predicted;FEV1 reversibility of >= 12% and 200ml after rescue
    Patient Weight Required: No
    Must Be Compliant with Therapy: No
    Non-smoker or Will Begin Smoking Cessation Efforts: No
    Symptoms Are Not Adequately Controlled: Yes
    Exacerbation Requiring Treatment with Systemic Corticosteroid: Optional
    Use in Combination with Other Injectable Asthma Product: No
    Positive Skin Test or In Vitro Test (RAST) to a Perennial Aeroallergen: No
    IgE Level Required: No
    Administered in a Controlled Healthcare Setting with Access to Emergency Medications: No
    Submission of Medical Records Required: No
    Eosinophilic asthma phenotype: Yes
    Injectable ST Required: No

    Asthma OCS Dependent:
    Age Requirement: >= 6
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified

    Atopic Dermatitis (Eczema):
    Age Requirement: >= 1
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified
    Initial Authorization - POEM Values: N/A
    Initial Authorization - SCORAD Values: N/A
    Initial Authorization - EASI Values: N/A
    Initial Authorization - IGA Values: N/A
    Initial Authorization - PGA Values: N/A
    Initial Authorization - ISGA Values: N/A
    Initial Authorization - BSA Values: N/A
    Physician Attestation for Initiation Required: No
    Step Trial Length Period: Variable
    Reauthorization Assessment Required: None

    Eosinophilic Esophagitis (EoE):
    Age Requirement: >= 12
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified

    Nasal Polyposis:
    Age Requirement: >= 18
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified

  • PA_APPLIES
  • PA_APPLIES