Actimmune (interferon gamma-1b) — Point32Health
Chronic Granulomatous Disease
Initial criteria
- Documented diagnosis of Chronic Granulomatous Disease
- Prescribed by or in consultation with an immunologist
Reauthorization criteria
- Documented diagnosis of Chronic Granulomatous Disease
- Prescribed by or in consultation with an immunologist
- Documentation the patient has experienced a therapeutic response defined by a reduction in the frequency and severity of serious infections associated with Chronic Granulomatous Disease
Approval duration
12 months