UnitedHealthcare
Cotellic (cobimetinib)
Drugs for Cancer : Drugs for Cancer
  • PA_APPLIES
  • Quantity Limit: 204 strips per 30 day(s).
  • Prior Authorization: Graft Versus Host Disease (GVHD):
    Documented Diagnosis: Yes
    Age Requirement: >= 12
    Duration: 12 Month(s)
    Reauthorization Required: Yes

    Myelofibrosis:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 1 plan year

    Polycythemia Vera (PV):
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 1 plan year
    Reauthorization Required: Yes

  • Orally administered anticancer medication. Zero copay may apply. Must be 35 or older and at increased risk for the first occurrence of breast cancer - after risk assessment and counseling.