HEMOPHILIA TREATMENT
Displaying 1 - 10 of 165 records found.| Brand Name/Generic Name | NDC/Manufacturer | FFS Clinical Prior Auth Required | PDL Prior Auth Required | Programs |
|---|---|---|---|---|
| ADVATE 1,201-1,800 UNIT VIAL antihemophil.FVIII,full length |
00944305402 BAXALTA US INC. |
No | No | Medicaid CHIP CSHCN |
| ADVATE 1,801-2,400 UNIT VIAL antihemophil.FVIII,full length |
00944304510 BAXALTA US INC. |
No | No | Medicaid CHIP CSHCN |
| ADVATE 2,401-3,600 UNIT VIAL antihemophil.FVIII,full length |
00944304610 BAXALTA US INC. |
No | No | Medicaid CHIP CSHCN |
| ADVATE 200-400 UNIT VIAL antihemophil.FVIII,full length |
00944305102 BAXALTA US INC. |
No | No | Medicaid CHIP CSHCN |
| ADVATE 3,601-4,800 UNIT VIAL antihemophil.FVIII,full length |
00944304710 BAXALTA US INC. |
No | No | Medicaid CHIP CSHCN |
| ADVATE 401-800 UNIT VIAL antihemophil.FVIII,full length |
00944305202 BAXALTA US INC. |
No | No | Medicaid CHIP CSHCN |
| ADVATE 801-1,200 UNIT VIAL antihemophil.FVIII,full length |
00944305302 BAXALTA US INC. |
No | No | Medicaid CHIP CSHCN |
| ADYNOVATE 1,251-2,500 UNIT VL antihemo.FVIII,full length peg |
00944462501 BAXALTA US INC. |
No | No | Medicaid CHIP CSHCN |
| ADYNOVATE 1,500 UNIT VIAL antihemo.FVIII,full length peg |
00944462701 BAXALTA US INC. |
No | No | Medicaid CHIP CSHCN |
| ADYNOVATE 200-400 UNIT VIAL antihemo.FVIII,full length peg |
00944462201 BAXALTA US INC. |
No | No | Medicaid CHIP CSHCN |