Limited Use Note(s)

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LAMIVUDINE100mg Tab
Reason For Use CodeClinical Criteria
502Confirmed chronic Hepatitis B infection in persons with - HBV DNA greater than or equal to 1000 IU/mL AND - ALT levels greater than ULN OR - Evidence of fibrosis or - Documented evidence of cirrhosis
LU Authorization Period: 1 year
503Patients with chronic Hepatitis B infection currently receiving treatment with lamivudine and requires treatment continuation.
LU Authorization Period: 1 year
504Patients with chronic Hepatitis B infection who are scheduled to undergo chemotherapy or significant immunosuppressive treatment.
LU Authorization Period: 1 year