Zuplenz (ondansetron oral soluble film) — Blue Cross Blue Shield of Alabama
Delayed emesis in highly emetogenic chemotherapy
Initial criteria
- Quantities above the program set limit will be approved when ONE of the following is met:
- • The patient has cancer chemotherapy related nausea and vomiting and will be receiving chemotherapy more than 7 days per month OR
- • The patient has delayed emesis in highly emetogenic chemotherapy OR
- • The patient has hyperemesis gravidarum OR
- • The patient has radiation therapy induced nausea and vomiting for radiation treatment that extends beyond 7 days per month
Approval duration
12 months