| Anthem Blue Cross (HMO, PPO, EPO) |
| Cotellic (cobimetinib) |
| Drugs for Cancer : Drugs for Cancer |
- Prior Authorization: Tumors Induced by VHL:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
- ST_APPLIES
- ST Applies
- PA Applies
- Quantity Limit: 1 capsule per 1 day(s).
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