Spring 2009

Prior authorization required for antifungals, growth hormone

Effective April 1, 2009, Blue Cross and Blue Shield of Florida (BCBSF) and Health Options implemented a prior authorization requirement for coverage on the antifungal products Vfend^® and Noxafil^®, as well as injectable growth hormones. The change is designed to ensure usage that meets drug manufacturers’ and Food and Drug Administration (FDA) approved label indications.

Vfend

Coverage for Vfend is provided for members with the following diagnoses:

• Invasive aspergillosis

• Candidemia in nonneutropenic patients and the following Candida infections: disseminated infections in skin and infections in abdomen, kidney, bladder wall and wounds

• Esophageal candidiasis

• Prophylaxis of invasive Aspergillus and Candida infection in patients who are at high risk due to being severely immunocompromised, such as hemotopoietic stem cell transplant (HSCT) recipients with graft-versus-host disease (GVHD) or those with hematologic malignancies with prolonged neutropenia from chemotherapy

• Serious fungal infections caused by Scedosporium apiospermum (sexual form of Pseudallescheria boydii) and Fusarium spp., including Fusarium solani , in patients intolerant of, or refractory to, other therapy

Noxafil

Coverage of Noxafil will be approved for patients with the following diagnoses:

• Prophylaxis of invasive Aspergillus and Candida infection in patients who are at high risk due to being severely immunocompromised, such as hemotopoietic stem cell transplant (HSCT) recipients with graft-versus-host disease (GVHD) or those with hematologic malignancies with prolonged neutropenia from chemotherapy, or a high-risk solid organ (lung, heart-lung, liver, pancreas, small bowel) transplant

• Treatment of oropharyngeal candidiasis, including oropharyngeal candidiasis refractory to itraconazole and/or fluconazole

New users of Vfend and Noxafil as of April 1, 2009, require prior authorization. Members using these drugs prior to April 1 will be given an authorization to continue to receive the medications for 12 months. Effective April 1, 2010, all users will require a prior authorization for coverage of Vfend or Noxafil.

Forms

The prior authorization request form for Vfend and Noxafil is available on our website at www.bcbsfl.com under Physicians & Providers, Pharmacy, Prior Authorization.

Growth hormones

As of April 1, 2009, prior authorization is required for prescription coverage of injectable growth hormones.

The growth hormone coverage  criteria are available on our website at www.bcbsfl.com under Physicians & Providers, Medical Information, Medical Policies, Pharmacy.

For growth hormone prior authorization requests, please call (800) 955-5692.