| Western Health Advantage - All plan years |
| Valchlor (mechlorethamine) |
| Drugs for the Skin : Drugs for the Skin |
- Quantity Limit: limit maximum 2 EA PER 1 day(s)
- Chronic Heart Failure (CHF):
Age Requirement: >= 1
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): Cardiologist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
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