| Western Health Advantage - All plan years |
| Kisqali (600 MG Dose) (ribociclib) |
| Drugs for Cancer : Drugs for Cancer |
- Multiple Sclerosis (MS):
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Patients Cardiac Medical History Required: No
Concomitant use of other MS medication: No
- Prior Authorization: Cytomegalovirus (CMV):
Duration: 1 year(s)
- Multiple Myeloma:
Age Requirement: >= 18
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Drug Policy Based On: Payer Specific
ECOG Score Requirement in Policy: N/A
ECOG status <=2: No
Diagnosis Types: Adult patients with relapsed or refractory multiple myeloma
- Quantity Limit: limit maximum 18 EA PER 30 day(s)
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