| Sutter Health Plus |
| Piqray (250 MG Daily Dose) (alpelisib) |
| Drugs for Cancer : Drugs for Cancer |
- Prior Authorization: NSCLC EGFR Mutated:
Documented Diagnosis: Yes
Age Requirement: < 19
Duration: 12 Month(s)
Reauthorization Required: Yes
- Step Therapy: ST_APPLIES
- PA_APPLIES
- Preventive Drug: $0 copay.
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