- Anti-Cancer: Maximum $200 copayment per State Law.
- Prior Authorization: Solid Tumor with NTRK Gene Fusion:
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
- Solid Tumor with NTRK Gene Fusion:
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): Oncologist
Reauthorization Required: Yes
Duration of Reauthorization: <= 12 month(s)
Specialty Pharmacy is Required: Not Defined
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