- Metastatic Castrate-Sensitive Prostate Cancer (mCSPC):
Age Requirement: >= 18
Duration: 1 plan year
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): 1 of Oncologist;Urologist
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
Metastatic Prostate Cancer: Age Requirement: >= 18
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): 1 of Oncologist;Urologist
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
- Anti-Cancer:Maximum $200 copayment per State Law. Limited Access. Must use AcariaHlth Specialty pharmacy.
- Diagnosis of metastatic, castration-resistant prostate cancer
- Prior Authorization: Metastatic Castrate-Sensitive Prostate Cancer (mCSPC):
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 1 plan year
Reauthorization Required: Yes
Metastatic Prostate Cancer: Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
- Step Therapy: ST Single Generic
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