Anthem Blue Cross (HMO, PPO, EPO)
Idelvion (factor IX rec, albumin fusion)
Drugs for the Blood : Drugs to Prevent Bleeding
  • Available only through Specialty Pharmacy;
    For FAX form click HERE
    Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
     Log in to Surescripts
     Log in to CoverMyMeds; For details on drug coverage click  HERE;
  • PA Applies
  • Step Therapy: Hemophilia B (Factor IX):
    ST Multiple Brands

  • Hemophilia B (Factor IX):
    Duration: 1 year(s)
    Documented Diagnosis: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Dosing Limit(s): N/A
    Treatment Center Required: No

  • Prior Authorization: Hemophilia B (Factor IX):
    Duration: 1 year(s)