- Anti-Cancer:Maximum $200 copayment per State Law.
- Basal Cell Carcinoma:
Age Requirement: >= 18
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): 1 of Oncologist
Reauthorization Required: No
Duration of Reauthorization: = 12 month(s)
- Prior Authorization: Basal Cell Carcinoma:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
|