| Western Health Advantage - All plan years |
| Chondroitin Sulfate (chondroitin sulf A sodium (PF)) |
| Drugs for the Eye : Drugs for the Eye |
- Prior Authorization: Endometrial Cancer:
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 1 year(s)
Hepatocellular Carcinoma, Kidney Cancer:
Documented Diagnosis: Yes
Duration: 1 year(s)
Thyroid Carcinoma:
Duration: 1 year(s)
- Myelofibrosis:
Age Requirement: >= 18
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: No
Duration of Reauthorization: N/A
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