Marqibo® (vincristine – liposome)
Authorization form
Traditional, Optimized & Medicaid (11/2018)
No prior authorization is required for Medicare Part B
No prior authorization required for:
- Emergency room
- Inpatient
- Skilled nursing facility
For further information, please see the Injectable Drugs page
Code(s): J9371
Benefit: Medical
Notes: Treatment of acute lymphoblatic leukemia (ALL)