Health Net
Mvasi 400 Mg/Ml Soln (Bevacizumab-Awwb)
Drugs for Cancer : Drugs for Cancer
  • Prior Authorization: Asthma (injectable):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 6
    Duration: 1 year(s)
    Reauthorization Required: Yes

    Asthma OCS Dependent:
    Documented Diagnosis: Yes
    Age Requirement: >= 6
    Duration: 1 year(s)
    Reauthorization Required: Yes

    Atopic Dermatitis (Eczema):
    Documented Diagnosis: Yes
    Age Requirement: >= 1
    Duration: 1 year(s)
    Reauthorization Required: Yes

    Eosinophilic Esophagitis (EoE):
    Documented Diagnosis: Yes
    Age Requirement: >= 12
    Duration: 1 year(s)
    Reauthorization Required: Yes

    Nasal Polyposis:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 1 year(s)
    Reauthorization Required: Yes

  • Quantity Limit: 28 tablets per 30 day(s).