HEMOPHILIA TREATMENT
Displaying 11 - 20 of 165 records found.| Brand Name/Generic Name | NDC/Manufacturer | FFS Clinical Prior Auth Required | PDL Prior Auth Required | Programs |
|---|---|---|---|---|
| ADYNOVATE 3,000 UNIT VIAL antihemo.FVIII,full length peg |
00944462801 BAXALTA US INC. |
No | No | Medicaid CHIP CSHCN |
| ADYNOVATE 401-800 UNIT VIAL antihemo.FVIII,full length peg |
00944462301 BAXALTA US INC. |
No | No | Medicaid CHIP CSHCN |
| ADYNOVATE 750 UNIT VIAL antihemo.FVIII,full length peg |
00944462601 BAXALTA US INC. |
No | No | Medicaid CHIP CSHCN |
| ADYNOVATE 801-1,250 UNIT VIAL antihemo.FVIII,full length peg |
00944462401 BAXALTA US INC. |
No | No | Medicaid CHIP CSHCN |
| AFSTYLA 1,000 UNIT VIAL antihem.FVIII,sin-chn,B-dm tru |
69911047602 CSL BEHRING LLC |
No | No | Medicaid CHIP CSHCN |
| AFSTYLA 2,000 UNIT VIAL antihem.FVIII,sin-chn,B-dm tru |
69911047702 CSL BEHRING LLC |
No | No | Medicaid CHIP CSHCN |
| AFSTYLA 250 UNIT VIAL antihem.FVIII,sin-chn,B-dm tru |
69911047402 CSL BEHRING LLC |
No | No | Medicaid CHIP CSHCN |
| AFSTYLA 3,000 UNIT VIAL antihem.FVIII,sin-chn,B-dm tru |
69911047802 CSL BEHRING LLC |
No | No | Medicaid CHIP CSHCN |
| AFSTYLA 500 UNIT VIAL antihem.FVIII,sin-chn,B-dm tru |
69911047502 CSL BEHRING LLC |
No | No | Medicaid CHIP CSHCN |
| ALPHANATE 1,000-400 UNIT VIAL antihemophilic factor/VWF |
68516461802 GRIFOLS |
No | No | Medicaid CHIP CSHCN |