- Quantity Limit: limit maximum 3 EA PER 1 day(s)
- Prior Authorization: Gastrointestinal Stromal Tumor, Kidney Cancer:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 1 plan year
Reauthorization Required: Yes
Neuroendocrine Tumor (NET):
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
- PA Applies
- Quantity Limit: limit maximum 30 day(s) supply
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