- 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
- May be covered under Medical Benefit.
- Pulmonary Arterial Hypertension:
Duration: 1 year(s)
- Step Therapy: Endometriosis:
ST Single Generic
|