Anthem Blue Cross (HMO, PPO, EPO)
anastrozole (anastrozole)
Drugs for Cancer : Drugs for Cancer
  • Prior Authorization: Granulomatosis with Polyangiitis:
    Documented Diagnosis: Yes
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Microscopic Polyangiitis (MPA):
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Acute Myeloid Leukemia:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Drug Policy Based On: 1 of FDA Approved Indications;NCCN Guidelines
    Quantity Limit: N/A
    Criteria for Reauthorization: No evidence of disease progression or unacceptable toxicity
    Diagnosis Types: 2 of Comorbidities that preclude the use of intensive induction chemotherapy;in combination with either azacitidine, decitabine, or cytarabine;Newly diagnosed AML where other medical conditions prevent the use of standard chemotherapy;Newly diagnosed with AML and age >= 60;Relapsed/Refractory acute myeloid leukemia
    Excludes Coverage in Maintenance Setting: No

    Chronic Lymphocytic Leukemia:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Drug Policy Based On: 1 of FDA Approved Indications;NCCN Guidelines
    Diagnosis Types: 1 of patients with CLL who have received at least one prior therapy;Small Lymphocytic Lymphoma