Anthem Blue Cross (HMO, PPO, EPO)
Tukysa (tucatinib)
Drugs for Cancer : Drugs for Cancer
  • Prior Authorization: PA_APPLIES
  • Step Therapy: ST_APPLIES
  • Step Therapy: Diabetic Medical Supplies:
    ST Single Brand

  • Prior Authorization: Amyotrophic Lateral Sclerosis (ALS):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 20
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Prior Authorization: Giant Cell Arteritis:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 1 year(s)

    Juvenile Idiopathic Arthritis:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 2
    Duration: 1 year(s)

    Rheumatoid Arthritis (RA):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 18
    Duration: 1 year(s)
    Reauthorization Required: Yes