Anthem Blue Cross (HMO, PPO, EPO)
Jevtana (cabazitaxel)
Drugs for Cancer : Drugs for Cancer
  • Ulcerative Colitis (UC):
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Gastroenterologist
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    TB Test required: No

  • Diabetic Retinopathy, Macular Edema, Macular Edema Following Retinal Vein Occlusion (RVO), Neovascular (Wet) Age-Related Macular Degeneration (AMD):
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Ophthalmologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)

    Myopic Choroidal Neovascularization (mCNV):
    Age Requirement: >= 18
    Duration: 3 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Ophthalmologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 3 month(s)

  • Prior Authorization: Narcolepsy Type 1, Narcolepsy Type 2:
    Documented Diagnosis: Yes
    Duration: 1 year(s)

    Neurology: Narcolepsy:
    PA Applies
  • Quantity Limit: limit maximum 1 EA PER 1 day(s)