Western Health Advantage - All plan years
Oxervate (cenegermin-bkbj)
Drugs for the Eye : Drugs for the Eye
  • Step Therapy: Derm: Acne Vulgaris:
    ST Single Generic

  • Orally administered anticancer medication.
  • Metastatic Castrate-Sensitive Prostate Cancer (mCSPC):
    Age Requirement: >= 18
    Duration: 1 plan year
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Oncologist;Urologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 plan year

    Metastatic Prostate Cancer:
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Oncologist;Urologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 plan year

  • Quantity Limit: limit maximum 0.02 EA PER 1 day(s)