- Step Therapy: Low Testosterone:
Step Applies
- Prior Authorization: Cholestatic Liver Disease:
Documented Diagnosis: Yes
Duration: 6 Month(s)
- Prior Authorization: Breast Cancer: HR+ (HER2+):
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
Gastric Cancer:
Duration: 12 Month(s)
- Quantity Limit: 10 tablets per 1 day(s).
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