Sutter Health Plus
Retevmo (selpercatinib)
Drugs for Cancer : Drugs for Cancer
  • PA_APPLIES
  • Quantity Limit: 6 packets per 1 day(s).
  • Prior Authorization: Acute Migraine, Migraine:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Migraine Prevention:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 3 Month(s)

  • Quantity Limit: limit maximum 4 EA PER 1 day(s)