| Anthem Blue Cross (HMO, PPO, EPO) |
| Fasenra (benralizumab) |
| Drugs for the Lungs : Drugs for Asthma/COPD |
- Asthma (injectable):
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Patient Weight Required: No
Must Be Compliant with Therapy: No
Non-smoker or Will Begin Smoking Cessation Efforts: No
Symptoms Are Not Adequately Controlled: No
Exacerbation Requiring Treatment with Systemic Corticosteroid: No
Use in Combination with Other Injectable Asthma Product: No
Positive Skin Test or In Vitro Test (RAST) to a Perennial Aeroallergen: No
IgE Level Required: No
Administered in a Controlled Healthcare Setting with Access to Emergency Medications: No
Submission of Medical Records Required: No
Eosinophilic asthma phenotype: No
Injectable ST Required: No
- Prior Authorization: Asthma (injectable):
Duration: 1 year(s)
- Quantity Limit: 1 syringe per 8 weeks(s).
- 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: Asthma (injectable):
ST Multiple Generics
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