Anthem Blue Cross (HMO, PPO, EPO)
Imfinzi (durvalumab)
Drugs for Cancer : Drugs for Cancer
  • Prior Authorization: Documented Diagnosis: Yes
    Duration: 1 year(s)

  • Available only through Specialty Pharmacy; Limited access;
    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;
  • NSCLC Systemic Therapy:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

    Small Cell Lung Cancer:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    ECOG Score Requirement Included in Policy: N/A
    Diagnosis Types: 3 of First line treatment;No previous therapy with a programmed death (PD-1/PD-L1)-directed therapy;Small Cell Lung Cancer
    Concomitant Therapy Requirement: 1 of carboplatin and etoposide;cisplatin and etopside

  • PA Applies