| Kaiser Foundation Health Plan Southern California |
| Erivedge (vismodegib) |
| Drugs for Cancer : Drugs for Cancer |
- Quantity Limit: 7 cans (420 grams) per month
- Prior Authorization: Granulomatosis with Polyangiitis:
Documented Diagnosis: Yes
Duration: 12 Month(s)
Microscopic Polyangiitis (MPA):
Duration: 12 Month(s)
|