HealthNet - All plan years
Noritate (metronidazole)
Drugs for the Skin : Drugs for the Skin
  • Prior Authorization: Endometrial Cancer:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Duration: 1 year(s)

    Hepatocellular Carcinoma:
    Documented Diagnosis: Yes
    Duration: 1 year(s)

    Thyroid Carcinoma:
    Duration: 1 year(s)

  • Quantity Limit: limit maximum 30 day(s) supply
  • ST Required
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