Anthem Blue Cross (HMO, PPO, EPO)
Jakafi (ruxolitinib)
Drugs for Cancer : Drugs for Cancer
  • Quantity Limit: limit maximum 1 EA PER 1 day(s)
  • Quantity Limit: 1 kit per 28 day(s).
  • PA Applies
  • Prior Authorization: PA_APPLIES
  • Quantity Limit: limit maximum 30 day(s) supply
  • Prior Authorization: Familial Amyloid Polyneuropathy (FAP):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes