UnitedHealthcare
Cotellic (cobimetinib)
Drugs for Cancer : Drugs for Cancer
  • Prior Authorization: Melanoma (MEL):
    Documented Diagnosis: Yes
    Age Requirement: < 19
    Duration: 12 Month(s)
    Reauthorization Required: Yes

  • Quantity Limit: limit maximum 63 EA PER fill retail
  • Melanoma (MEL):
    Age Requirement: < 19
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

  • Orally administered anticancer medication.