Payer PolicyActive
Interferon Alfa-n3 (Alferon N)
EVICORE-MEDICAL_DRUG-02BA3AF5
EviCore by Evernorth
Effective: January 1, 2019
Updated: January 13, 2026
created · Dec 4, 2025
Policy Summary
Alferon N (interferon alfa‑n3) is covered only for the FDA‑approved indication of refractory or recurring external genital warts (condyloma acuminatum); off‑label uses are not supported. Coverage requires no anaphylactic sensitivity to egg protein, neomycin, or mouse IgG and is authorized for up to 16 weeks.
Coverage Criteria Preview
Key requirements from the full policy
"Condyloma acuminatum, refractory or recurring external genital warts"
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Covered Medical Codes