| Anthem Blue Cross (HMO, PPO, EPO) |
| Profilnine 1,200 (+/-) Unit Solr (factor IX cplx(pcc)no4,3factor) |
| Drugs for the Blood : Drugs to Prevent Bleeding |
- Hemophilia B (Factor IX):
Duration: 1 year(s)
Documented Diagnosis: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Dosing Limit(s): N/A
Treatment Center Required: No
- Prior Authorization: Hemophilia B (Factor IX):
Duration: 1 year(s)
- Step Therapy: Hemophilia B (Factor IX):
ST Multiple Brands
|