- Chronic Lymphocytic Leukemia:
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): 1 of Hematologist;Oncologist
Reauthorization Required: No
Duration of Reauthorization: N/A
Drug Policy Based On: Payer Specific
Concomitant Therapy Requirement: 1 of chlorambucil;fludarabine and cyclophosphamide
Diagnosis Types: 1 of CLL for relapsed/refractory disease;extended use in complete/partial response after >= 2 lines of therapy for recurrent/progressive CLL;first line in combination with chlorambucil where fludarabine therapy is inappropriate;for the treatment of patients with CLL refractory to fludarabine and alemtuzumab
- Prior Authorization: Chronic Lymphocytic Leukemia:
Documented Diagnosis: Yes
Duration: 12 Month(s)
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