Anthem Blue Cross (HMO, PPO, EPO)
Hexalen (altretamine)
Drugs for Cancer : Drugs for Cancer
  • PA Applies

  • 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;
  • Prior Authorization: Ovarian Cancer:
    Documented Diagnosis: Yes
    Duration: 1 year(s)

  • Ovarian Cancer:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Drug Policy Based On: FDA Approved Indications
    Diagnosis Types: 3 of As monotherapy;Ovarian Cancer;persistent or recurrent disease

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