Ferriprox (tablets and oral solution) — Medica
any FDA-approved indication(s) for oral iron chelators
Preferred products
- generic deferasirox tablets
- generic deferasirox tablets for suspension
- generic deferasirox granules
- generic deferiprone tablets
Initial criteria
- Patient meets the respective standard Chelating Agents – Iron Chelators (Oral) Prior Authorization Policy criteria
- Patient has had a trial of at least one Preferred Product
Approval duration
as noted in standard Chelating Agents – Iron Chelators (Oral) Prior Authorization Policy