| Anthem Blue Cross (HMO, PPO, EPO) |
| Lenvima (18 MG Daily Dose) (lenvatinib) |
| Drugs for Cancer : Drugs for Cancer |
- Step Therapy: Thyroid Carcinoma:
ST Single Brand
- Available only through Specialty Pharmacy; 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;
- Endometrial Cancer:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: No
Duration of Reauthorization: N/A
Hepatocellular Carcinoma:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Duration of Reauthorization: N/A
Diagnosis Types: 2 of Advanced disease;Hepatocellular Cancer;Unresectable disease
ECOG Score Requirement Included in Policy: N/A
Kidney Cancer:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Drug Policy Based On: NCCN Guidelines
ECOG Score Requirement Included in Policy: N/A
Policy Includes Reference to Coverage for Non Clear Cell Histology: No
If Non-Clear Cell Histology is Referenced in Policy is There a Trial and Failure Requirement: No
Concomitant Use With: 1 of Afinitor (everolimus);Keytruda
Thyroid Carcinoma:
Duration: 1 year(s)
- Quantity Limit: 1 pack per 30 day(s).
- Prior Authorization: Endometrial Cancer:
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 1 year(s)
Hepatocellular Carcinoma, Kidney Cancer:
Documented Diagnosis: Yes
Duration: 1 year(s)
Thyroid Carcinoma:
Duration: 1 year(s)
- PA Applies
|