Intron A (interferon alfa-2b) — CareFirst (Caremark)

Initial criteria

• Authorization may be granted for treatment of chronic hepatitis C virus infection.

Reauthorization criteria

• Authorization may be granted for continued treatment up to a total of 96 weeks when the member is receiving clinical benefit and there is no evidence of unacceptable toxicity while on the current regimen.

Approval duration

16 weeks initial; up to 96 weeks total for continuation