| Anthem Blue Cross (HMO, PPO, EPO) |
| Wilate 900-900 Unit Solr (antihemophilic factor-vWF) |
| Drugs for the Blood : Drugs to Prevent Bleeding |
- Hemophilia A (Factor VIII):
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Dosing Limit(s): N/A
Diagnosis Type(s): 1 of Mild to moderate;Severe
Diagnosis Treatments: 1 of Bleeding episodes;Routine propylaxis
Treatment Center Required: No
Von Willebrand Disease:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Dosing Limit(s): N/A
Treatment Center Required: No
Dosing Limits Exist: No
- Prior Authorization: Hemophilia A (Factor VIII):
Documented Diagnosis: Yes
Duration: 1 year(s)
- Step Therapy: Von Willebrand Disease:
ST Generic and Brand
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