| Anthem Blue Cross (HMO, PPO, EPO) |
| Treanda 45 Mg/0.5 Ml Soln (bendamustine) |
| Drugs for Cancer : Drugs for Cancer |
- Chronic Lymphocytic Leukemia:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Drug Policy Based On: Payer Specific
Diagnosis Types: 1 of Chronic Lymphocytic Leukemia;Small Lymphocytic Lymphoma
Multiple Myeloma:
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 in Policy: N/A
ECOG status <=2: No
Diagnosis Types: 2 of Multiple Myeloma;Progressive disease;Relapsed disease
- Prior Authorization: Documented Diagnosis: Yes
Duration: 1 year(s)
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