| Anthem Blue Cross (HMO, PPO, EPO) |
| Truseltiq (125MG Daily Dose) (infigratinib) |
| Drugs for Cancer : Drugs for Cancer |
- PA Applies
- Cholangiocarcinoma:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: No
Duration of Reauthorization: N/A
- Quantity Limit: 1 carton per 28 day(s).
- Prior Authorization: Cholangiocarcinoma:
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 1 year(s)
- May process through Pharmacy or Medical benefit depending on Patient location;
For FAX form click HERE
Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
Log in to Surescripts
Log in to CoverMyMeds; For details on drug coverage click HERE;
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