Kaiser Foundation Health Plan Southern California
Cotellic (cobimetinib)
Drugs for Cancer : Drugs for Cancer
  • Prior Authorization: Ankylosing Spondylitis (AS), Psoriasis (PsO), Psoriatic Arthritis (PsA), Rheumatoid Arthritis (RA), Ulcerative Colitis (UC):
    Documented Diagnosis: Yes
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Crohn's Disease (CD):
    Documented Diagnosis: Yes
    Age Requirement: >= 6
    Duration: 12 Month(s)
    Reauthorization Required: Yes

  • Quantity Limit: limit maximum 4 EA PER 30 day(s)