| Anthem Blue Cross (HMO, PPO, EPO) |
| Bendeka (bendamustine) |
| Drugs for Cancer : Drugs for Cancer |
- PA Applies
- Derm: Onychomycosis:
Age Requirement: >= 18
Duration: 48 week(s)
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 48 week(s)
Treatment for non-cosmetic purposes: No
Documented Size of Fungal Infection: N/A
Documented Trial and Failure Length of Generic Penlac: N/A
Patient Must Not Also Be Using With an Oral Antifungal Agent: No
Re-approval not allowed: No
Supporting Documentation Requirements: Chart Notes
Documented Diagnosis: Yes
Size of fungal infection <= 50% involvement: No
Patient must have documented failure of at least 48 weeks of generic Penlac: No
Concomitant drug therapy not allowed: No
- Step Therapy: ST_APPLIES
- Bipolar:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Psychiatry: Schizophrenia:
Duration: 1 year(s)
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Policy Requires Documentation of Patient Noncompliance to Oral Therapy: No
Established tolerability to oral formulation: No
Documented Diagnosis: Yes
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