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
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