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Eli Lilly and Company / Clinical pharmacology / Amines / Immunosuppressants / Methadone / Food and Drug Administration / Leflunomide / Chemistry / Pharmacology / Pharmaceutical sciences


PA Criteria Prior Authorization Group Drug Names Covered Uses Exclusion Criteria Required Medical Information
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Document Date: 2014-10-01 01:21:37


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Company

Lennox / HP / /

Event

Product Issues / FDA Phase / /

MedicalCondition

Collagen diseases / Ophthalmic disorders / Waldenstrom's macroglobulinemia/lymphoplasmacytic lymphoma / atopic dermatitis / seizures / HIV-wasting syndrome / uncontrolled hypertension / angiomyolipoma / pulmonary arterial hypertension / chronic renal failure / rheumatoid arthritis / active systemic juvenile idiopathic arthritis / nephritis / chronic thromboembolic pulmonary hypertension / anaphylaxis / suspected nephrosis / hepatitis B / metastatic disease / lymphangioleiomyomatosis / Serum sickness / multiple sclerosis / iritis / peptic ulcer disease / Sezary syndrome / breast cancer / PNETs / cryopyrin-associated periodic syndromes / familial cold auto-inflammatory syndrome / suspected carcinoma / immunodeficiency disease / keratitis / Muckle-Wells syndrome / liver cell tumors / renal angiomyolipoma / pulmonary angiography / autoantibody formation/lupus / rheumatic diseases / soft tissue sarcoma / perivascular epithelioid cell tumors / congenital infection / Symptomatic sarcoidosis / myelosuppressive cancer / Scheie syndrome / myeloid cancer / simplex / congestive heart failure / systemic fungal infection / chronic disease / osteoporosis / deficiency / multifocal white matter disease / symptomatic anemia / DIPHTHERIA/TETANUS TOXOID / systemic lupus erythematosus / TB / spondylitis / myelodysplastic syndromes / either Waldenström's macroglobulinemia/lymphoplasmacytic lymphoma / Turner's syndrome / active polyarticular juvenile idiopathic arthritis / infantile spasms / Stevens-Johnson syndrome / severely active rheumatoid arthritis / lung neuroendocrine tumors / AND clinically evident emphysema / selective IgA deficiency / demyelinating disorder / hypersensitivity / self-injectable tumor necrosis factor / HER2-negative disease / MS / mycosis fungoides / psoriatic arthritis / proteinuria / TETANUS/DIPHTHERIA TOXOID / severe allergic reaction / severe erythema multiforme / primary adrenocortical insufficiency / scleroderma / peliosis hepatis / pulmonary endarterectomy / optic neuritis / Dermatologic disorders / nephrotic syndrome / familial short QT Syndrome / heart failure / hypercalcemia / SCID / ocular herpes / suspected hypercalcemia / anemia / dermatomyositis / syndrome / polymyositis / /

MedicalTreatment

surgery / contraception / dialysis / chemotherapy / phototherapy / heart catheterization / /

Organization

World Health Organization / FDA / /

Position

candidate for curative surgical resection / physician / candidate for bone marrow transplantation / /

Product

METHYLPREDNISOLONE / CARBOPLATIN / LEUCOVORIN CALCIUM / TOPOSAR / HERCEPTIN / CISPLATIN / VELCADE / TRAVASOL / AMINOSYN-RF / APOKYN / ARANESP / ACETYLCYSTEINE / CYCLOSPORINE / CYTARABINE / PROLEUKIN / BLEOMYCIN SULFATE / exemestane / DEXTROSE / FLO-PRED / ELITEK / AVASTIN / VINCRISTINE SULFATE / BUSULFEX / KEPIVANCE / METHOTREXATE SODIUM / AVONEX / PULMOZYME / MITOMYCIN / AMINOSYN-PF / ALDURAZYME / anastrozole / ADRUCIL / AMBISOME / TREXALL / SOLU-MEDROL / ZANOSAR / ALBUTEROL SULFATE / VECTIBIX / DEXRAZOXANE / SANDIMMUNE / NEBUPENT / ETOPOSIDE / PREDNISOLONE / theophylline / PACLITAXEL / AMPHOTEC / Nexavar / OXANDROLONE / VINBLASTINE SULFATE / UVADEX / PERFOROMIST / LIDOCAINE / IFEX / IXEMPRA KIT / TORISEL / H.P. Acthar Gel / PREDNISONE / AZATHIOPRINE / VINORELBINE TARTRATE / ERBITUX / HUMULIN R / NEPHRAMINE / ADAGEN / LIPOSYN / CALCITRIOL / Humira / MESNA / VANCOMYCIN HCL / GRANISETRON / BICNU / PAMIDRONATE DISODIUM / ORAPRED ODT / MORPHINE SULFATE / REMODULIN / ABELCET / SIMULECT / leflunomide / NEORAL / MEDROL / ALIMTA / CLADRIBINE / CLOLAR / IPRATROPIUM BROMIDE / ELOXATIN / DILAUDID-HP / CROMOLYN SODIUM / CYCLOPHOSPHAMIDE / GENGRAF / ABRAXANE / CESAMET / AZASAN / IFOSFAMIDE / INTRALIPID / AMINOSYN-HBC / ZOMETA / FREAMINE / TREANDA / MUSTARGEN / TRISENOX / BETASERON / FREAMINE HBC / RAPAMUNE / ZEMPLAR / LEVOCARNITINE / CELLCEPT / HEPATAMINE / TOBRAMYCIN / TPN ELECTROLYTES / BROVANA / PREMASOL / INFUMORPH / AMPHOTERICIN B / Enbrel / letrozole / TROPHAMINE / DEPO-PROVERA / AMINOSYN / VINCASAR PFS / AMIFOSTINE / FASLODEX / GANCICLOVIR / DEPO-MEDROL / ARRANON / PROCALAMINE / ELIGARD / HEPATASOL / PULMICORT / dipyridamole / PROGRAF / CAMPTOSAR / VENTAVIS / CUBICIN / FLUDARABINE PHOSPHATE / ARCALYST / ACYCLOVIR SODIUM / FLUOROURACIL / PREDNISONE INTENSOL / adenosine / MIACALCIN / ACTIMMUNE / ACTHAR / MITOXANTRONE / HEPARIN SODIUM / Sutent / TAXOTERE / DACARBAZINE / ondansetron / response / 5HT3 / ALPHA1-PROTEINASE / /

ProvinceOrState

Mississippi / /

Technology

chemotherapy / dialysis / alpha / antibodies / transplantation / MRI / /

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