| Anthem Blue Cross (HMO, PPO, EPO) |
| Treanda (bendamustine) |
| Drugs for Cancer : Drugs for Cancer |
- PA Applies
- PA Applies
- Anti-Cancer:Maximum $200 copayment per State Law.
- Cystic Fibrosis (CF):
Age Requirement: >= 6
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): CF Specialist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Documented Mutation in the CFTR Gene: Yes
Documented Homozygous F508del Mutation in the CFTR Gene: Yes
Pseudomonas Aeruginosa Culture Required: No
Baseline FEV1 Value (percent predicted): N/A
FEV1 ImprovementMaintenance for Reauthorization: Yes
Liver Function Test Required: No
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