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Limited Coverage Drugs - Special Authority Criteria
| Generic Name / Strength / Form |
| deferasirox |
| Criteria |
Approval Period |
| Treatment of transfusion-dependent conditions where iron chelation therapy is required, according to established criteria*, and when prescribed by a hematologist. |
Initial request: 1 year
Renewal request: 1 year |
Practitioner Exemptions
- No practitioner exceptions
Special Notes
Forms
* Click on the Special Authority Form below for full criteria:
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