- Quantity Limit: limit maximum 1,200 ML PER 180 day(s)
- Prior Authorization: PA_APPLIES
- Breast Cancer: HR+ (HER2+):
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Oncologist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
- Prior Authorization: PA Applies
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