UnitedHealthcare - 2014 to Present
Kisqali (400 MG Dose) (ribociclib)
Drugs for Cancer : Drugs for Cancer

  • For FAX form click HERE
    Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
     Log in to Surescripts
     Log in to CoverMyMeds; For details on Quantity drug coverage click HERE;
  • Quantity Limit: 113 grams per 30 day(s).
  • Quantity Limit: limit maximum 0.02 EA PER 1 day(s)
  • Prior Authorization: Pain Narcotic: Opioid:
    Documented Diagnosis: Yes
    Duration: 24 Month(s)
    Reauthorization Required: Yes

  • Prior Authorization: Cystic Fibrosis (CF):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 2
    Duration: 1 year(s)
    Reauthorization Required: Yes

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