Specialtydrug.magellanprovider.com

Zoledronic acid (Zometa®, Reclast®)

Coverage is provided in the following conditions: Hypercalcemia of malignancy † Multiple myeloma † Bone metastases from solid tumors † Prevention of … See more

Actived: 4 days ago

URL: https://specialtydrug.magellanprovider.com/media/47195/zoledronic_acid.pdf

Zoledronic acid: Zometa®; Reclast®

Category: Health Go Health

Specialty Pharmacy Home Page

WebAt Magellan Rx Management, we believe physician business processes should be simple and efficient. Take advantage of our online resources to easily request or review …

Category: Health Go Health

Health New England PA

WebZoladex (goserelin acetate). Zoledronic Acid Zometa Reclast Health New England Site-of-Service. View HNE Site of Service Policy. View Magellan/HNE Site of Service FAQ. …

Category: Health Go Health

Security Health Plan PA

WebSecurity Health Plan Clinical Guidelines Effective July 1, 2023 - Step Therapy requirements for Medicare outpatient (Part B) medications

Category: Health Go Health

Independent Health PA

WebIndependent Health Clinical Guidelines. Please Note: Criteria may differ by line of business. Review the appropriate policy for specific criteria or refer to the Part D or Part B Step …

Category: Health Go Health

Policies and Guidelines

WebMedication Center. Policies and Guidelines. Policies and Guidelines. Please note that some of our health plan customers require login for their clinical policies to be displayed to …

Category: Health Go Health

Magellan Rx Specialty Provider Providers User Sign In

Category: Health Go Health

Imfinzi (durvalumab)

WebPage 5 | Imfinzi® (durvalumab) Prior Auth Criteria Proprietary Information. Restricted Access – Do not disseminate or copy without approval.

Category: Health Go Health

SCIG (immune globulin SQ): Hizentra®, Gammagard Liquid®, …

WebTo calculate the initial weekly dose, divide the monthly IVIG dose in grams by the number of weeks between IGIV infusions and then multiply this value with a Dose …

Category: Health Go Health

Zynteglo® (betibeglogene autotemcel)

Websubmission. Please provide documentation related to diagnosis, step therapy, and clinical markers (i.e., genetic and mutational testing) supporting initiation when applicable.

Category: Health Go Health

Esketamine (Spravato®) Criteria

WebPage 2 | Spravato Suggested Utilization Management – September 2020 Proprietary Information. Restricted Access – Do not disseminate or copy without approval.

Category: Health Go Health

Hemgenix® (etranacogene dezaparvovec-drlb)

WebCalculate the dose as follows: − Hemgenix dose (in mL) = patient body weight (in kilogram) x 2. The multiplication factor 2 represents the per kilogram dose (2 × 1013 gc/kg) divided …

Category: Health Go Health

Hemgenix® (etranacogene dezaparvovec

WebCalculate the dose as follows: Hemgenix dose (in mL) = patient body weight (in kilogram) x 2. The multiplication factor 2 represents the per kilogram dose (2 × 1013 …

Category: Health Go Health

Independent Health PSCE

WebOncaspar. (pegaspargase) Rylaze. (asparaginase Erwinia chrysanthemi (recombinant)‐rywn) Xeomin. (incobotulinumtoxinA) Independent Health applies pre …

Category: Health Go Health

Remicade® (infliximab)

WebRemicade 100 mg single-use vial: 10 vials every 4 weeks. B. Max Units (per dose and over time) [Medical Benefit]: Loading Dose: Rheumatoid Arthritis (RA) 40 …

Category: Medical Go Health

Pluvicto® (lutetium Lu 177 vipivotide tetraxetan)

WebThe recommended Pluvicto dosage is 7.4 GBq (200 mCi) intravenously every 6 weeks (up to 10 weeks for toxicities) for up to 6 doses, or until disease progression, or …

Category: Health Go Health