Sutter Health Plus
Valchlor (mechlorethamine)
Drugs for the Skin : Drugs for the Skin
  • Prior Authorization: Chronic Lymphocytic Leukemia:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 12 Month(s)
    Reauthorization Required: Yes

    Follicular Lymphoma (FL):
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Prior Authorization: PA Applies
  • Quantity Limit: limit maximum 10 ML PER fill retail
  • Quantity Limit: limit maximum 30 day(s) supply