UnitedHealthcare
Fotivda (tivozanib)
Drugs for Cancer : Drugs for Cancer
  • Quantity Limits Apply
  • Kidney Cancer:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Drug Policy Based On: Payer Specific
    ECOG Score Requirement Included in Policy: N/A
    Policy Includes Reference to Coverage for Non Clear Cell Histology: No
    If Non-Clear Cell Histology is Referenced in Policy is There a Trial and Failure Requirement: No

  • Orally administered anticancer medication.
  • Prior Authorization: Kidney Cancer:
    Documented Diagnosis: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes