- Multiple Myeloma:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Drug Policy Based On: FDA Approved Indications
ECOG Score Requirement in Policy: N/A
ECOG status <=2: No
Diagnosis Types: Multiple Myeloma
- Orally administered anticancer medication
- Quantity Limit: 4 capsules per day)
- Prior Authorization: Multiple Myeloma:
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
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