Ferriprox (tablets and oral solution) — Medica
patients who meet the standard Chelating Agents – Iron Chelators (Oral) Prior Authorization Policy criteria
Preferred products
- generic deferasirox tablets
- generic deferasirox tablets for suspension
- generic deferasirox granules
- generic deferiprone tablets
Initial criteria
- Patient meets the standard Chelating Agents – Iron Chelators (Oral) Prior Authorization Policy criteria; AND
- Patient has tried ONE of generic deferasirox tablets, generic deferasirox tablets for suspension, generic deferasirox granules, or generic deferiprone tablets.
Approval duration
1 year