Health Net
Gonal-f RFF Rediject (follitropin alfa)
Hormones : Drugs for Women
  • Endometrial Cancer:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: No
    Duration of Reauthorization: N/A

    Hepatocellular Carcinoma:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Duration of Reauthorization: N/A
    Diagnosis Types: 2 of Advanced disease;Hepatocellular Cancer;Unresectable disease
    ECOG Score Requirement Included in Policy: N/A

    Thyroid Carcinoma:
    Duration: 1 year(s)

  • Quantity Limit: 420 grams per 28 day(s).
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