Cigna + Oscar
Ibrance (palbociclib)
Drugs for Cancer : Drugs for Cancer
  • Prior Authorization: PA Applies
  • Prior Authorization: PA_APPLIES
  • Rheumatoid Arthritis (RA):
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    TB Test required: No

  • 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

    Kidney Cancer:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Drug Policy Based On: NCCN Guidelines
    ECOG Score Requirement Included in Policy: N/A
    Policy Includes Reference to Coverage for Non Clear Cell Histology: No
    If Non-Clear Cell Histology is Referenced in Policy is There a Trial and Failure Requirement: No
    Concomitant Use With: 1 of Afinitor (everolimus);Keytruda

    Thyroid Carcinoma:
    Duration: 1 year(s)