- Quantity Limit: 1 capsule per day
- Prior Authorization: Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
- Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
- Step Therapy: ST Single Brand
- Orally administered anticancer medication.
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