Anthem Blue Cross (HMO, PPO, EPO) |
Jelmyto (mitomycin) |
Drugs for Cancer : Drugs for Cancer |
- PA Applies
- Urothelial/Bladder Cancer:
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: Urothelial carcinoma
ECOG Score Requirement Included in Policy: N/A
- Prior Authorization: Urothelial/Bladder Cancer:
Documented Diagnosis: Yes
Duration: 1 year(s)
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;
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