- Prior Authorization: Solid Tumor with NTRK Gene Fusion:
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
- Solid Tumor with NTRK Gene Fusion:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Specialty Pharmacy is Required: Not Defined
- Quantity Limit: limit maximum 10 ML PER 1 day(s)
- Orally administered anticancer medication.
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