Health Net
Cytogam (cytomegalovirus immune glob)
Biological Agents : Biological Agents
  • Prior Authorization: Cytomegalovirus (CMV):
    Documented Diagnosis: Yes
    Duration: 16 week(s)

  • Cytomegalovirus (CMV):
    Duration: 16 week(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Cardiologist;Gastroenterologist;Hepatologist;Immunologist;Nephrologist;Pulmonologist;Transplant Specialist
    Reauthorization Required: No
    Duration of Reauthorization: N/A

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