| Anthem Blue Cross (HMO, PPO, EPO) |
| Kyprolis (carfilzomib) |
| Drugs for Cancer : Drugs for Cancer |
- PA Applies
- Prior Authorization: Documented Diagnosis: Yes
Duration: 1 year(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;
- 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: 1 of All NCCN indications with evidence level of 2A or higher;as a single agent for the treatment of relapsed or refractory multiple myeloma after one or more lines of therapy;in combination with dexamethasone in relapsed or refractory multiple myeloma after one to three line of therapy;in combination with lenalidomide plus dexamethasone in relapsed or refractory multiple myeloma after one to three line of therapy;Multiple Myeloma;Patients who have received at least 2 prior regimens including a PI and an immunomodulatory agent;Primary treatment in combination with lenalidomide and dexamethasone
Concomitant Therapy Requirement: 1 of Dexamethasone and Sarclisa (isatuximab);in combination with daratumumab and dexamethasone;in combination with dexamethasone;in combination with lenalidomide and dexamethasone;in combination with panobinostat;in combination with pomalidomide and dexamethasone
Waldenstrom Macroglobulinemia:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
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