- Available through Specialty Pharmacy;
- Prior Authorization: NSCLC EGFR Mutated:
Documented Diagnosis: Yes
Duration: 1 year(s)
- PA Required
- Quantity Limit: 30 day supply per 1 fill(s).
- NSCLC EGFR Mutated:
Duration: 1 year(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Oncologist
Reauthorization Required: No
Duration of Reauthorization: N/A
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