| Anthem Blue Cross - 2014 to Present (HMO, PPO, EPO) |
| Kisqali Femara (600 MG Dose) (ribociclib-letrozole) |
| Drugs for Cancer : Drugs for Cancer |
- PA_APPLIES
- ST_APPLIES
- Bipolar:
Age Requirement: >= 10
Duration: 1 plan year
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
Major Depressive Disorder:
Age Requirement: >= 18
Duration: 12 Month(s)
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Documented Diagnosis: Yes
Psychiatry: Schizophrenia:
Age Requirement: >= 13
Duration: 1 plan year
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
Policy Requires Documentation of Patient Noncompliance to Oral Therapy: No
Established tolerability to oral formulation: No
Documented Diagnosis: Yes
|