Anthem Blue Cross (HMO, PPO, EPO)
Lonsurf (trifluridine-tipiracil)
Drugs for Cancer : Drugs for Cancer
  • Colorectal Cancer:
    Duration: 1 year(s)
    Documented Diagnosis Requirement: Explicitly Documented
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Drug Policy Based On: FDA Approved Indications
    Documented Diagnosis: Yes
    Specialty Pharmacy is Required: Not Defined

  • Available only through Specialty Pharmacy; May process through Pharmacy or Medical benefit depending on Patient location;
    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;
  • PA Applies
  • Prior Authorization: Colorectal Cancer:
    Documented Diagnosis: Yes
    Duration: 1 year(s)