Health Net
Lorbrena (lorlatinib)
Drugs for Cancer : Drugs for Cancer
  • Anti-Cancer: Maximum $200 copayment per State Law. Must use AcariaHealth Specialty Rx. SF Split Fill
  • NSCLC ALK+ OR ROS1+ Disease:
    Age Requirement: >= 18
    Duration: 12 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): Oncologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

  • Prior Authorization: NSCLC ALK+ OR ROS1+ Disease:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 18
    Duration: 12 Month(s)
    Reauthorization Required: Yes