| HealthNet - All plan years |
| Kisqali (200 MG Dose) (ribociclib) |
| Drugs for Cancer : Drugs for Cancer |
- Prior Authorization: Multiple Sclerosis (MS):
Documented Diagnosis: Yes
Duration: 2 Month(s)
Reauthorization Required: Yes
Secondary Progressive Multiple Sclerosis:
Documented Diagnosis: Yes
Reauthorization Required: Yes
- Prior Authorization: PA_APPLIES
- Quantity Limit: limit maximum 200 EA PER 30 day(s)
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