- Prior Authorization: Melanoma (MEL):
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
- Quantity Limit: limit maximum 6 EA PER 1 day(s)
- Step Therapy: Melanoma (MEL):
ST Multiple Brands
- Orally administered anticancer medication.
- Melanoma (MEL):
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
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