Anthem Blue Cross (HMO, PPO, EPO)
NexAVAR (sorafenib)
Drugs for Cancer : Drugs for Cancer
  • 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;
  • PA Applies
  • Acute Myeloid Leukemia:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Drug Policy Based On: NCCN Guidelines
    Supporting Documentation Requirements: FLT3 mutation as detected by an FDA-approved test
    Quantity Limit: N/A
    Use of Biomarkers in Policy: FLT3 mutation
    Diagnosis Types: 2 of FLT3 mutation-positive AML detected by FDA-approved test;Post Remission Therapy;Relapsed/Refractory acute myeloid leukemia
    Excludes Coverage in Maintenance Setting: No

    Gastrointestinal Stromal Tumor:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

    Hepatocellular Carcinoma:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialty Pharmacy Provider(s): Unspecified
    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
    Specialty Pharmacy Provider(s): Unspecified
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Drug Policy Based On: Payer Specific
    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

    Soft Tissue Sarcoma:
    Duration: 1 year(s)
    Reauthorization Required: No
    Medical Test Required: No
    Specialty Pharmacy Provider(s): Unspecified
    Duration of Reauthorization: N/A
    Drug Policy Based On: NCCN Guidelines
    Diagnosis Types: Soft tissue sarcoma
    Physician attestation of diagnostic or lab test required: No
    ECOG Score Requirement Included in Policy: N/A
    Documented Diagnosis: Yes

    Thyroid Carcinoma:
    Duration: 1 year(s)

  • Quantity Limit: 4 tablets per 1 day(s).
  • Prior Authorization: Acute Myeloid Leukemia:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Duration: 1 year(s)

    Gastrointestinal Stromal Tumor, Hepatocellular Carcinoma, Kidney Cancer, Soft Tissue Sarcoma:
    Documented Diagnosis: Yes
    Duration: 1 year(s)

    Thyroid Carcinoma:
    Duration: 1 year(s)