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