- Quantity Limit: 30 day supply per 1 fill(s).
- Ovarian Cancer:
Duration: 1 year(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Oncologist
Reauthorization Required: No
Duration of Reauthorization: N/A
Drug Policy Based On: Payer Specific
Diagnosis Types: 4 of As monotherapy;epithelial ovarian, fallopian tube, or primary peritoneal cancer;maintenance treatment after a complete or partial response to platinum-based chemotherapy;Recurrent disease;Treated with at least 2 prior lines of platinum based chemotherapy
- Prior Authorization: Ovarian Cancer:
Documented Diagnosis: Yes
Duration: 1 year(s)
- Available through Specialty Pharmacy;
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