| Anthem Blue Cross (HMO, PPO, EPO) |
| Piqray (300 MG Daily Dose) (alpelisib) |
| Drugs for Cancer : Drugs for Cancer |
- Quantity Limit: 30 day(s) supply
- Step Therapy: ST_APPLIES
- Step Therapy: ST_APPLIES
- Step Therapy: ST Multiple Generics
- Prior Authorization: Acromegaly:
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 12 Month(s)
Neuroendocrine Tumor (NET), Oncology: Carcinoid Syndrome:
Documented Diagnosis: Yes
Duration: 12 Month(s)
|