Gleevec — Medica
any/all FDA-approved indication(s) for imatinib per Oncology – Imatinib Prior Authorization Policy
Preferred products
- generic imatinib
Initial criteria
- Patient meets standard Oncology – Imatinib Prior Authorization Policy criteria AND
- Patient has tried a Preferred Product OR meets exception criteria
Approval duration
as noted in Oncology – Imatinib Prior Authorization Policy