| Western Health Advantage |
| Kisqali Femara (400 MG Dose) (ribociclib-letrozole) |
| Drugs for Cancer : Drugs for Cancer |
- Prior Authorization: Assisted Reproductive Technology (ART):
Documented Diagnosis: Yes
Duration: 3 Month(s)
- Step Therapy: ST_APPLIES
- Prior Authorization: Chronic Heart Failure (CHF):
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
- Quantity Limit: 204 lancets per 30 day(s).
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