Commercial Payer Information

Commercial Payer Information

Payers create their own policies with regard to product coverage. Since information varies by payer, it is important to contact the payer directly or consult its Web site to obtain product-specific coverage.

Exceptions and Appeals for Drug Therapies: A Guide for Healthcare Providers
How to Request an Exception or Appeal a Decision From Your Prescription Drug Plan

Uniform Prescription Drug Prior Authorization Request Form & Notification Requirements for Health Plans

California, Colorado and Oregon require that certain health plans must use the uniform Prior Authorization (PA) Request Form. In addition, there are new rules regarding the PA process. The rules are effective based on the type of health plan for each state. Click on the PDF below for more information:

The information below provides a summary of each payer's general exceptions and appeals process, which may pertain to services as well as to drugs and products. Some payers provide additional and specific exceptions and appeals information in the individual drug formularies. For this information, refer to the specific formulary.

Disclaimer: Janssen Products, LP, the maker of SYLVANT®, does not endorse and is not responsible for the content on any of the Web sites listed below. Clicking on any of the links below will take you to a Web site to which this privacy policy does not apply. We encourage you to read the privacy policy of every Web site you visit.

Payer Prior Authorization Information
Aetna Pharmacy Clinical Policy Bulletins and Prior Authorization
Arkansas Blue Cross and Blue Shield Prior Authorization Request Form
Blue Cross of Idaho Provider Prior Authorization Requirements: Pharmacy Requests
Blue Cross and Blue Shield of Alabama Specialty Pharmacy Form
Blue Cross Blue Shield of Arizona Prior Authorization Guidelines
Blue Cross and Blue Shield of Florida/Florida Blue Medication Guides
Quantity Limit Request Form
Specialty Pharmacy Request Form
Blue Cross and Blue Shield of Illinois Prior Authorization and Step Therapy Programs
Blue Cross and Blue Shield of Kansas Prescription Drugs
Prior Authorization
Blue Cross and Blue Shield of Minnesota Minnesota Uniform Form for PA Requests and Formulary Exceptions
Blue Cross and Blue Shield of Montana Provider Forms
Pharmacy Prior Authorization
Blue Cross and Blue Shield of Nebraska Policies & Forms: Pre-Authorization Forms
Blue Cross and Blue Shield of New Mexico Prior Authorization and Step Therapy Programs
Blue Cross and Blue Shield of North Carolina Prior Review and Limitations
Blue Cross and Blue Shield of Oklahoma Prior Authorization and Step Therapy Programs
BlueCross BlueShield of South Carolina Prior Authorization
BlueCross BlueShield of Texas Prior Authorization and Step Therapy Programs
Blue Cross Blue Shield of Wyoming Pharmacy Guide & Forms
CareFirst BlueCross BlueShield Prior Authorization/Step Therapy
Cigna Pharmacy Forms
CVS Caremark Prior Authorization Information
Electronic Prior Authorization
Electronic Prior Authorization FAQs
Clinical Prior Authorization Criteria Request Form
Geisinger Health/Geisinger Health Plan Prior Authorization Form
Gundersen Health Plan Pharmacy Forms for Healthcare Providers: Prior Authorization
Highmark Blue Cross Blue Shield Process for Requesting Drug Coverage from a Pharmaceutical Management Program
Highmark Blue Cross Blue Shield (formerly Blue Cross of Northeastern Pennsylvania) Provider Rx Prior Authorization Form
Drug Utilization Management Criteria
Humana Provider Prior Authorization
Independence Blue Cross Prior Authorization: Pharmacy Benefit
Midwest Health Plan, Inc. Pharmacy Approval Criteria
Medical Mutual of Ohio Provider Area
Prior Approval List
Prior Authorization Form
Neighborhood Health Plan Standardized Prior Authorization Request Form
Regence BlueCross BlueShield RegenceRx Pharmacy page
Prior Authorization Form
Wellmark Blue and Cross Blue Shield Provider Drug Information
Provider Prior Authorization
Indication

SYLVANT® (siltuximab) is indicated for the treatment of patients with Multicentric Castleman's Disease (MCD) who are human immunodeficiency virus (HIV) negative and human herpesvirus-8 (HHV-8) negative.

Limitation of Use. SYLVANT® was not studied in patients with MCD who are HIV-positive or HHV-8 positive because SYLVANT® did not bind to virally produced IL-6 in a nonclinical study.

Important Safety Information For SYLVANT®

CONTRAINDICATIONS – Severe hypersensitivity reaction to siltuximab or any of the excipients in SYLVANT®.

Concurrent Active Severe Infections – Do not administer to patients with severe infections until the infection resolves. SYLVANT® may mask signs and symptoms of acute inflammation including suppression of fever and of acute phase reactants such as C-reactive protein (CRP). Monitor patients closely for infections. Institute prompt anti-infective therapy and do not administer further SYLVANT® until the infection resolves.

Vaccinations – Do not administer live vaccines to patients receiving SYLVANT® because interleukin-6 (IL-6) inhibition may interfere with the normal immune response to new antigens.

Infusion Related Reactions and Hypersensitivity – Stop the infusion if the patient develops signs of anaphylaxis. Discontinue further therapy.

Stop the infusion if the patient develops mild to moderate infusion reactions. If the reaction resolves, the infusion may be restarted at a lower infusion rate. Consider medicating with antihistamines, acetaminophen, and corticosteroids. Discontinue SYLVANT® if the patient does not tolerate the infusion following these interventions.

Administer SYLVANT® in a setting that provides resuscitation equipment, medication, and personnel trained to provide resuscitation.

Gastrointestinal (GI) Perforation – Use with caution in patients who may be at increased risk for GI perforation. Promptly evaluate patients presenting with symptoms that may be associated with or suggestive of GI perforation.

Adverse Reactions – The most common adverse reactions (>10% compared to placebo) in the MCD clinical trial were pruritus, increased weight, rash, hyperuricemia, and upper respiratory tract infection.

Drug Interactions Cytochrome P450 (CYP450) Substrates – Upon initiation or discontinuation of SYLVANT®, in patients being treated with CYP450 substrates with narrow therapeutic index, perform therapeutic monitoring of effect (e.g., warfarin) or drug concentration (e.g., cyclosporine or theophylline) as needed and adjust dose. Exercise caution when SYLVANT® is co-administered with CYP3A4 substrate drugs where a decrease in effectiveness would be undesirable (e.g., oral contraceptives, lovastatin, atorvastatin).

Please click here to read full Prescribing Information for SYLVANT®.

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