Western Health Advantage
Vizimpro (
dacomitinib
)
Drugs for Cancer : Drugs for Cancer
Step Therapy: ST_APPLIES
Prior Authorization: Acute Lymphoblastic Leukemia:
Documented Diagnosis: Yes
Duration: 1 year(s)
May be covered under Medical Benefit.
Quantity Limit: limit maximum 200 EA PER 30 day(s)
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