HealthNet - All plan years
Xtandi (enzalutamide)
Drugs for Cancer : Drugs for Cancer
  • Prior Authorization: Duchenne Muscular Dystrophy (DMD):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 7
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • ST_APPLIES
  • Quantity Limit: 100 grams per 30 day(s).
  • Prior Authorization: Documented Diagnosis: Yes
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Diabetic Medical Supplies:
    Duration: 1 year(s)
    Documented Diagnosis: No
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

  • Prior Authorization: Diabetic Medical Supplies:
    Documented Diagnosis: Yes
    Duration: 1 plan year
    Reauthorization Required: Yes