Anthem Blue Cross (HMO, PPO, EPO) |
Jadenu Sprinkle (deferasirox) |
Drugs for Overdose or Poisoning : Drugs for Overdose or Poisoning |
- 1;
- Prior Authorization: Chronic Lymphocytic Leukemia:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 12 Month(s)
Reauthorization Required: Yes
Mantle Cell Lymphoma: Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 1 plan year
Reauthorization Required: Yes
- Hemophilia A (Factor VIII):
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Hematologist
Reauthorization Required: Yes
Duration of Reauthorization: <= 6 month(s)
Dosing Limit(s): Variable
Diagnosis Type(s): 1 of Mild;Severe
Diagnosis Treatments: 1 of Bleeding episodes;Peri-procedural operative management;Routine propylaxis
Treatment Center Required: No
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