Nascobal (cyanocobalamin) — Highmark
treatment or prevention of vitamin B12 deficiency in adult patients not due to pernicious anemia when dietary, drug-induced, or malabsorption-related
Initial criteria
- age ≥ 18 years
- AND
- (vitamin B12 level > 300 pg/mL following intramuscular cyanocobalamin therapy OR vitamin B12 level ≤ 300 pg/mL and not a candidate for continued intramuscular cyanocobalamin therapy)
Reauthorization criteria
- prescriber attests that the member has experienced a positive clinical response to therapy
Approval duration
12 months