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
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