- Myelodysplastic Syndrome:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Quantity Limit: 8 tablets per 30 day(s).
- Prior Authorization: Pulmonary Arterial Hypertension:
Duration: 1 year(s)
- PA Required
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