Anthem Blue Cross (HMO, PPO, EPO) |
Tagrisso (osimertinib) |
Drugs for Cancer : Drugs for Cancer |
- Quantity Limit: 1 canister (6.8 grams) per month
- PA Applies
- Step Therapy: ST Required
- Quantity Limit: limit maximum 120 GM PER 30 day(s)
- Prior Authorization: Breast Cancer: HR+ (HER2-):
Age Requirement: <= 19
Duration: 12 Month(s)
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