| Health Net |
| Mircera (epoetin beta, methoxy peg) |
| Drugs for the Blood : Drugs for the Blood |
- Anemia:
Age Requirement: >= 18
Duration: 6 Month(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Initial Therapy HgbHCT Requirements: Hgb < 10g/dL
Initial Therapy Iron Stores Requirements: serum ferritin >= 100 ng/mL AND TSAT >= 20%
Discontinuation requirements: No
Reauthorization Requirements Iron Stores: serum ferritin >= 100 ng/mL AND TSAT >= 20%
- Prior Authorization: Anemia:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
- Step Therapy: Anemia:
ST Single Brand
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