Anthem Blue Cross (HMO, PPO, EPO)
Kisqali Femara (400 MG Dose) (ribociclib-letrozole)
Drugs for Cancer : Drugs for Cancer
  • Quantity Limit: 8 capsules per 1 day(s).
  • Quantity Limit: 4 tablets per 1 day(s).
  • Quantity Limit: 2 vials per 6 day(s).
  • PA Applies
  • Neurology: Epilepsy:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Diagnosis Type(s): Partial-Onset Seizures
    Used as Adjunctive Treatment: No
    Duration of Failure or Adjunctive Treatment with Other Antiepileptic Product: N/A
    Documented history of persisting seizures after titration to highest tolerated dose of each AED.: Yes
    Lack of compliance as a reason for treatment failure has been ruled out: Yes
    Documentation of treatment failure due to intolerable side effects.: Yes
    Positive Response to Therapy Required for Reauth: No
    Treatment for Age 17 years or older: No
    Treatment for Age 1-16 years old: No
    History of >= to 30 day trial of other AED required: No
    Reapproval based on response: No