Emflaza tablets — Cigna
Duchenne muscular dystrophy in patients age ≥ 2 years
Preferred products
- generic deflazacort tablets
Initial criteria
- Patient meets the standard Muscular Dystrophy – Deflazacort Prior Authorization Policy criteria; AND
- Patient has tried generic deflazacort tablets [documentation required]; AND
- Patient cannot take deflazacort tablets due to a formulation difference in the inactive ingredient(s) [e.g., difference in dyes, fillers, preservatives] between the brand and bioequivalent generic product which, per the prescriber, would result in a significant allergy or serious adverse reaction [documentation required]
Approval duration
1 year