Tasigna Prior Authorization Criteria

By , October 23, 2013 9:11 am

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Tasigna Prior Authorization Criteria

Prior Authorization Criteria Drug: Tasigna® (nilotinib … – ConnectiCare
Prior Authorization Criteria. Drug: Tasigna® (nilotinib). P&T Reviewed: 12/07, 6/ 08, 9/09, 9/10, 12/11, 10/12. Description: Nilotinib is a kinase inhibitor. It is an …

Tasigna (nilotinib) pharmacy prior authorization approval criteria
Page 1 of 3. 03/12/08. Prior Authorization Approval Criteria. Department of Pharmacy Services. Generic Name: Nilotinib. Brand Name: Tasigna. Medication  …

kinase inhibitors for leukemia prior authorization criteria
Jan 17, 2013 … KINASE INHIBITORS FOR LEUKEMIA PRIOR AUTHORIZATION CRITERIA. Bosulif (bosutinib). Sprycel (dasatinib). Tasigna (nilotinib).

Prior Authorization of Benefits APPROVAL DURATION 1 … – Anthem
Prior Authorization of Benefits. APPROVAL DURATION. 1 year. APPROVAL CRITERIA. Tasigna (nilotinib) may be approved if the following criteria are met:.

Tasigna (nilotinib) – Anthem
(nilotinib). Prior Authorization of Benefits (PAB) Form. Complete form in its entirety and fax to: … APPROVAL CRITERIA: CHECK ALL BOXES THAT APPLY.
Document ID#: 2119252 Subject: Tasigna … – Tufts Health Plan
Mar 4, 2008 … Clinical Documentation and Prior … Authorization Criteria. … Tufts Health Plan may authorize coverage of Tasigna (nilotinib) for Members, …
Tasigna®, nilotinib – Regence
Policy/Criteria. I. Most contracts require prior authorization approval of nilotinib prior to coverage. Nilotinib may be considered medically necessary when all of …
Med D PA Form – Tasigna – Arkansas Blue Cross and Blue Shield
Tasigna (Medicare Prior Authorization). This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign …
Iclusig® (ponatinib) Prior Authorization Form – RMHP
Jan 31, 2013 … Patient had resistance and/or intolerance to prior TKIs. … NCCN guidelines call Iclusig a potent pan-BCR-ABL inhibitor with … phases of CML in patients resistant or intolerant to dasatinib and nilotinib (MCyR and CCyR.
Nilotinib (Tasigna®) – Oxford Health Plans
Nov 15, 2012 … prior written notice unless otherwise required by Oxford’s administrative procedures or applicable state law. The term Oxford … Authorization Required … Tasigna will be covered based on the following criterion: • Member is …
Pharmaceuticals – Novartis
Jul 2, 2013 … for Tasigna than for Gleevec/Glivec, with the difference in favor of. Tasigna … is approved as neo-adjuvant (pre-operative) therapy for early stage breast cancer in a ….. include additional requirements (blood pressure monitoring and ECG) during the ….. In 2012, Novartis submitted marketing authorization.
Prior Authorization Criteria – Medicare Supplement Plans …
Jun 20, 2013 … Trillium Medicare Advantage TLC ISNP HMO. Trillium Medicare Advantage TLC Community ISNP HMO. Prior Authorization Criteria. 2013.
Prior Authorization Criteria Updated 7/2013 – Physicians United Plan
Jul 1, 2013 … Prior Authorization Criteria. 2013 PUP …. Prior authorization applies to new starts only. … (imatinib), Sprycel (dasatinib), or Tasigna (nilotinib) …
Chronic Myeloid Leukemia – The Leukemia & Lymphoma Society
(Tasigna®), can bind to the Bcr-Abl tyrosine kinase (protein) and block its effects. The specific …. this phase, or CML symptoms may be present prior to treatment due to changes ….. “genetic” test and will only authorize a single such test per lifetime. … For information about the CML mutation testing guidelines from the NCCN,.
Important information for healthcare professionals … – Novartis Canada
Apr 9, 2013 … TASIGNA” belongs to the pharmacological class of protein-tyrosine kinase inhibitors. It has received conditional marketing authorization for the treatment of adult patients with newly diagnosed … one prior therapy, including imatinib. … care professionals follow current clinical guidelines for the diagnosis …
Prior authorization criteria for: – Providence
PROVIDENCE ELDERPLACE. PRIOR AUTHORIZATION CRITERIA INDEX. Actimmune® (interferon gamma-1B) …………………………………………………………………….. 4.
May 2013 – Premera Blue Cross
May 2, 2013 … Prior Authorization/POS Edit … both meet the actuarial value requirements and cover the specific essential health …… Dasatinib (Sprycel®) and Nilotinib ( Tasigna®) may be considered medically necessary in patients with …
Iclusig (ponatinib) Prior Authorization Form – Cat Health Benefits
May 1, 2013 … Sprycel® (dasatinib). Tasigna® (nilotinib) … covered on all plans. DOCTOR’S NOTE: Caterpillar Prior Authorization forms are located at www.
Prior Authorization Guidelines – Alameda Alliance for Health
Jul 1, 2013 … Prior Authorization Requirements. Effective Date: …. CRITERIA. TRIAL OF OR CONTRAINDICATION TO GLEEVEC, SPRYCEL, OR TASIGNA.
2013 Prior Authorization Drugs (Non-Medicare) – OPERS
2013 Prior Authorization Drugs (Non-Medicare). Condition … Drugs in this list include genetic testing as a criteria for approval. Condition. Brand Name Drug. Cancer. Erbitux, Gleevec, Herceptin, Sprycel, Tasigna, Tykerb, Vectibix,. Xalkon …

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