Anthem Blue Cross (HMO, PPO, EPO)
Xpovio (60 MG Once Weekly) (selinexor)
Drugs for Cancer : Drugs for Cancer
  • PA Applies
  • Prior Authorization: Documented Diagnosis: Yes
    Duration: 1 year(s)

  • Quantity Limit: 12 tablets per 28 week(s).
  • May process through Pharmacy or Medical benefit depending on Patient location;
    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;
  • Diffuse Large B-Cell Lymphoma:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

    Multiple Myeloma:
    Duration: 1 year(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Oncologist
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Drug Policy Based On: Payer Specific
    ECOG Score Requirement in Policy: N/A
    ECOG status <=2: No
    Diagnosis Types: 1 of in combination with dexamethasone for the treatment of relapsed or refractory multiple myeloma who have received at least four prior therapies and refractory to at least two proteasome inhibitors at least two immunomodulatory agents,and an anti-CD38 monoclonal antibody;patients who have received at least one prior therapy
    Concomitant Therapy Requirement: 1 of in combination with bortezomib and dexamethasone;in combination with dexamethasone