Anthem Blue Cross (HMO, PPO, EPO)
Kisqali (400 MG Dose) (ribociclib)
Drugs for Cancer : Drugs for Cancer

  • For FAX form click HERE
    Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
     Log in to Surescripts
     Log in to CoverMyMeds; For details on drug coverage click  HERE;
  • PA Applies
  • Quantity Limit: limit maximum 30 day(s) supply
  • Phenylketonuria (PKU):
    Age Requirement: >= 18
    Duration: 12 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): 1 of Endocrinologist;Geneticist;Metabolic Specialist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

  • Step Therapy: Gaucher Disease:
    ST Single Brand