Health Net
Livtencity (maribavir)
Drugs for Infections : Drugs for Viral Infections
  • Step Therapy: Cytomegalovirus (CMV):
    ST Single Generic

  • Prior Authorization: Cytomegalovirus (CMV):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 12
    Duration: 8 week(s)
    Reauthorization Required: Yes

  • Cytomegalovirus (CMV):
    Age Requirement: >= 12
    Duration: 8 week(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: <= 8 week(s)