- ST_APPLIES
- Orally administered anticancer medication.
- Prior Authorization: Head and Neck Cancer:
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
NSCLC EGFR Mutated: Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: < 19
Duration: 12 Month(s)
Reauthorization Required: Yes
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