| HealthNet - All plan years |
| Kitabis Pak (tobramycin with nebulizer) |
| Drugs for the Lungs : Drugs for Cystic Fibrosis |
- PA Required
- Prior Authorization: Multiple Myeloma:
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
- QL (1 per Rx);
|