Intron A (interferon alfa-2b) — CareFirst (Caremark)
Chronic hepatitis B (including hepatitis D virus co-infection) virus infection
Initial criteria
- Authorization may be granted for treatment of chronic hepatitis B (including hepatitis D virus co-infection) virus infection.
Reauthorization criteria
- Authorization may be granted up to a total of 24 weeks when the member is receiving clinical benefit and there is no evidence of unacceptable toxicity while on current regimen.
Approval duration
16 weeks initial; up to 24 weeks total for continuation