Health Net
Trelstar 11.25 Mg/2 Ml Syrg (triptorelin pamoate)
Drugs for Cancer : Drugs for Cancer
  • Prior Authorization: Metastatic Prostate Cancer:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Non-Metastatic Prostate Cancer:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 12 Month(s)
    Reauthorization Required: Yes

  • Metastatic Prostate Cancer:
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Oncologist;Urologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)

    Non-Metastatic Prostate Cancer:
    Age Requirement: >= 18
    Duration: 12 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Oncologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)