UnitedHealthcare
Balversa (erdafitinib)
Drugs for Cancer : Drugs for Cancer
  • Orally administered anticancer medication.
  • Quantity Limit: limit maximum 3 EA PER 1 day(s)
  • Urothelial/Bladder Cancer:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Drug Policy Based On: NCCN Guidelines
    Diagnosis Types: 3 of disease progression during or following platinum-containing chemotherapy;FGFR3 or FGFR2 mutation-positive as detected by an FDA approved test;Locally advanced or metastatic urothelial carcinoma;Progression within 12 mos. of neoadjuvant or adjuvant treatment with platinum-containing regimen
    ECOG Score Requirement Included in Policy: N/A

  • Prior Authorization: Urothelial/Bladder Cancer:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes