- Prior Authorization: Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
- Metastatic Castrate-Sensitive Prostate Cancer (mCSPC):
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Specialty Pharmacy Provider(s): 1 of Avella Specialty Pharmacy;Optum Specialty Pharmacy
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
Metastatic Prostate Cancer: Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
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