| Kaiser Foundation Health Plan Southern California - All plan years |
| Kepivance (palifermin) |
| Drugs for the Stomach : Drugs for the Stomach |
- Quantity Limit: 3 mg per 1 day(s).
- Prior Authorization: Cystic Fibrosis (CF):
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
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