- Prior Authorization: Breast Cancer: PIK3CA:
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
- Subject to initial 7-day limit;
- PA_APPLIES
- 1. Health Net Approved Indications and Usage Guidelines: A. Confirmed diagnosis of PAH (WHO Group 1); OR B. Confirmed diagnosis of CTEPH (WHO Group 4) after surgical treatment or inoperable CTEPH. 2. Coverage is Not Authorized For: a. Non-FDA approved indications, which are not listed in the Health Net Approved Indications and usage guidelines section unless there is sufficient documentation of efficacy and safety in the published literature. b. Patients on concomitant phosphodiesterase (PDE) inhibitors or nitrates. 3. Recommended Authorization Limit: Length of benefit.
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