- Step Therapy Applies
- Prior Authorization: Chemo-induced Nausea and Vomiting (CINV):
Documented Diagnosis: Yes
Reauthorization Required: Yes
- Chemo-induced Nausea and Vomiting (CINV):
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: Unspecified
NV associated with highly emetogenic cancer chemotherapy (HEC): No
NV associated with moderately emetogenic cancer chemotherapy (MEC): No
Concomitant therapy with Corticosteroid: No
Concomitant therapy with 5-HT3 Antagonist: No
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