Anthem Blue Cross (HMO, PPO, EPO)
Rituxan (rituximab)
Drugs for Cancer : Drugs for Cancer
  • Pain Narcotic: Opioid:
    Age Requirement: >= 18
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Diagnosis Type(s): Chronic Pain
    Used for Cancer Patients: No
    Around-The-Clock Analgesic Required: No
    Morphine Equivalent Dose (MED) Limit: N/A
    Morphine Equivalent Dose (MED) Required: No

  • Hemophilia A (Factor VIII):
    Duration: 3 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Hematologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 3 month(s)
    Dosing Limit(s): Variable
    Diagnosis Type(s): 1 of Mild;Severe
    Diagnosis Treatments: 1 of Bleeding episodes;Routine propylaxis
    Treatment Center Required: No

  • Prior Authorization: PA_APPLIES
  • Quantity Limit: 4 patches per 28 day(s).
  • Prior Authorization: Derm: Acne Vulgaris:
    Documented Diagnosis: Yes
    Age Requirement: >= 12
    Duration: 12 week(s)
    Reauthorization Required: Yes

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