UnitedHealthcare
HumuLIN R U-500 KwikPen (insulin regular hum U-500 conc)
Hormones : Drugs for Diabetes
  • Colorectal Cancer:
    Duration: 1 year(s)
    Documented Diagnosis Requirement: Explicitly Documented
    Medical Test Required: Yes
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Drug Policy Based On: NCCN Guidelines
    Documented Diagnosis: Yes
    Specialty Pharmacy is Required: Not Defined

    Gastrointestinal Stromal Tumor:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

    Hepatocellular Carcinoma:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Duration of Reauthorization: N/A
    Diagnosis Types: 2 of For patients who received previous treatment with Nexavar/sorafenib;Hepatocellular Cancer
    ECOG Score Requirement Included in Policy: N/A

    Soft Tissue Sarcoma:
    Duration: 1 year(s)
    Reauthorization Required: No
    Medical Test Required: No
    Specialty Pharmacy Provider(s): Unspecified
    Duration of Reauthorization: N/A
    Drug Policy Based On: NCCN Guidelines
    Diagnosis Types: 3 of as a single agent;Gastrointestinal stromal tumor (GIST);Pleomorphic rhabdomyosarcoma;Rhabdomyosarcoma;Soft tissue sarcoma;Solitary fibrous tumor/hemangiopericytoma;Unresectable or metastatic
    Physician attestation of diagnostic or lab test required: No
    ECOG Score Requirement Included in Policy: N/A
    Documented Diagnosis: Yes

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