- Available through Specialty Pharmacy;
- Urothelial/Bladder Cancer:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Drug Policy Based On: Payer Specific
Diagnosis Types: Urothelial carcinoma
ECOG Score Requirement Included in Policy: N/A
- Quantity Limit: 2 tablets per 1 day(s).
- PA_APPLIES
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