| Anthem Blue Cross (HMO, PPO, EPO) |
| Monoclate-P 250 (+/-) Unit Kit (antihemophilic factor) |
| Drugs for the Blood : Drugs to Prevent Bleeding |
- Hemophilia A (Factor VIII):
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
- Step Therapy: Hemophilia A (Factor VIII):
ST Multiple Brands
- Prior Authorization: Hemophilia A (Factor VIII):
Duration: 1 year(s)
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