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  • rockystar996 rockystar996 Jul 23, 2013 12:23 AM Flag

    omontys become effective from july 9 2013 tufts health plan medicare

    Document ID#: 2209773 Subject: Omontys (peginesatide) Effective Date: July 9, 2013
    Clinical Documentation and Prior Authorization Required
    Type of Review – Clinical Review √ Pharmacy (RX) or Medical (MED) Benefit MED Administrative Process (Internal Use Only) LPN
    Note: This pharmacy medical necessity guideline applies to commercial products. For Tufts Health Plan Medicare Preferred members, please refer to the Tufts Health Plan Medicare Preferred Prior Authorization Criteria. Background, applicable product and disclaimer information can be found on the

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