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

  • PA Applies
  • Available only through Specialty Pharmacy; May process through Pharmacy or Medical benefit depending on Patient location; 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;
  • Ovarian Cancer:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Drug Policy Based On: 1 of Clinical Pharmacology;NCCN Guidelines
    Diagnosis Types: 2 of Advanced disease;Advanced ovarian, fallopian tube or primary peritoneal cancers after 3 or more prior chemo regimens with HRD+ mutations by deleterious or suspected deleterious BRCA mutation or genomic instability and progression >6 months after response to the last platinum-based therapy;epithelial ovarian, fallopian tube, or primary peritoneal cancer;maintenance treatment after a complete or partial response to platinum-based chemotherapy;Recurrent disease
    Supporting Documentation Requirements: Homologous recombination deficiency (HRD) testing

  • Quantity Limit: 3 capsules per 1 day(s).