Health Net
Abraxane (paclitaxel protein-bound)
Drugs for Cancer : Drugs for Cancer
  • Breast Cancer: HR+ (HER2-):
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes

    Breast Cancer: HR+ (HER2+), NSCLC Systemic Therapy, Pancreatic Cancer, Uveal Melanoma:
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Oncologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

    Breast Cancer: Triple Negative:
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): Oncologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

    Cervical Cancer:
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Unspecified
    Reauthorization Required: Yes
    Duration of Reauthorization: <= 12 month(s)

    Endometrial Cancer:
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Oncologist
    Reauthorization Required: Yes
    Duration of Reauthorization: <= 6 month(s)

    Ovarian Cancer:
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Oncologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Drug Policy Based On: NCCN Guidelines
    Diagnosis Types: 2 of All NCCN indications with evidence level of 2A or higher;Ovarian Cancer;Relapsed disease

  • Prior Authorization: Breast Cancer: HR+ (HER2-):
    Age Requirement: >= 18
    Duration: 6 Month(s)

    Breast Cancer: HR+ (HER2+), Endometrial Cancer, NSCLC Systemic Therapy, Ovarian Cancer, Pancreatic Cancer, Uveal Melanoma:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Breast Cancer: Triple Negative:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Cervical Cancer:
    Documented Diagnosis: Yes
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Step Therapy: Breast Cancer: HR+ (HER2+):
    ST Single Generic

    Cervical Cancer:
    ST Multiple Generics

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