UnitedHealthcare
Thalomid (thalidomide)
Drugs for Cancer : Drugs for Cancer
  • Multiple Myeloma:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Drug Policy Based On: FDA Approved Indications
    ECOG Score Requirement in Policy: N/A
    ECOG status <=2: No
    Diagnosis Types: Multiple Myeloma

  • Orally administered anticancer medication.
  • Quantity Limit: limit maximum 8 EA PER 1 day(s)
  • Prior Authorization: Multiple Myeloma:
    Documented Diagnosis: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes