Anthem Blue Cross (HMO, PPO, EPO) |
Duavee (conj estrogens-bazedoxifene) |
Hormones : Drugs for Women |
- Quantity Limit: 1 container per day
- Step Therapy: Insomnia:
ST Single Generic
- Step Therapy: Diabetic Medical Supplies:
ST Single Brand
- Multiple Myeloma:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Drug Policy Based On: NCCN Guidelines
ECOG Score Requirement in Policy: N/A
ECOG status <=2: No
Diagnosis Types: 2 of All NCCN indications with evidence level of 2A or higher;Multiple Myeloma;Patients who have received at least 2 prior regimens including a PI and an immunomodulatory agent;patients who have received at least one prior therapy;patients with disease progression on or within 60 days of completion of the last therapy
Concomitant Therapy Requirement: 1 of in combination with cyclophosphamide and dexamethasone;in combination with dexamethasone;in combination with lenalidomide and dexamethasone;in combination with pomalidomide and dexamethasone
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