- Quantity Limit: limit maximum 1 EA PER 1 day(s)
- Anti-Cancer:Maximum $200 copayment per State Law. Anti-Cancer: Maximum $200 copayment per State Law.
- Prior Authorization: Neuroendocrine Tumor (NET):
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
- Neuroendocrine Tumor (NET):
Age Requirement: >= 18
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Oncologist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
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