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)