| Anthem Blue Cross (HMO, PPO, EPO) |
| Tabrecta (capmatinib) |
| Drugs for Cancer : Drugs for Cancer |
- PA Required
- May be covered under Medical Benefit.
- Prior Authorization: Documented Diagnosis: Yes
Duration: 1 year(s)
- Quantity Limit: limit maximum 1 EA PER 1 day(s)
- Derm: Acne Vulgaris:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Limited to non-cosmetic use: Yes
|