Actimmune (interferon gamma-1b) — Point32Health

Initial criteria

• Documented diagnosis of Severe, Malignant Osteoporosis
• Prescribed by or in consultation with an endocrinologist

Reauthorization criteria

• Documented diagnosis of Severe, Malignant Osteoporosis
• Prescribed by or in consultation with an endocrinologist
• Documentation the patient has experienced a therapeutic response defined by an absence of disease progression (e.g., significant reduction in hemoglobin or platelet counts, serious bacterial infection requiring antibiotics, 50 decibel decrease in hearing, progressive optic atrophy)

Approval duration

12 months