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Coverage Decisions & Cited Evidence for:

 

Health Plan Coverage Step Therapy Protocol Patient Subgroup Restriction Prescriber Requirement Combination Restriction Other Restriction
AetnaMore restrictive than FDA labelNoYesNoNoNo
AnthemMore restrictive than FDA labelNoYesNoNoNo
BCBS FloridaConsistent with FDA labelNoNoNoNoNo
BCBS MassachusettsMore restrictive than FDA labelYesNoNoNoNo
BCBS MichiganMore restrictive than FDA labelNoYesYesNoNo
BCBS New JerseyConsistent with FDA labelNoNoNoNoNo
BCBS North CarolinaConsistent with FDA labelNoNoNoNoNo
BCBS TennesseeMore restrictive than FDA labelYesYesNoNoNo
CareFirstMore restrictive than FDA labelYesNoNoNoNo
CenteneMore restrictive than FDA labelNoNoYesNoNo
CignaMore restrictive than FDA labelNoYesYesNoNo
EmblemMore restrictive than FDA labelNoNoYesNoNo
Health Care Service CorporationConsistent with FDA labelNoNoNoNoNo
HighmarkConsistent with FDA labelNoNoNoNoNo
HumanaConsistent with FDA labelNoNoNoNoNo
Independence BCMore restrictive than FDA labelYesNoNoNoNo
KaiserMore restrictive than FDA labelYesNoNoNoNo
UnitedHealthcareConsistent with FDA labelNoNoNoNoNo
Coverage Policy

Coverage Policy

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Reauthorization Criteria

Reauthorization Criteria

Approval Duration

Approval Duration

Coverage Decisions by Indication
Cited Evidence by Indication