- Quantity Limit: 30 day supply per 1 fill(s).
- Metastatic Prostate Cancer:
Duration: 6 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Non-Metastatic Prostate Cancer:
Duration: 6 Month(s)
Gender Requirement: Male
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Available through Specialty Pharmacy;
- PA Required
- Prior Authorization: Metastatic Prostate Cancer:
Documented Diagnosis: Yes
Duration: 6 Month(s)
Non-Metastatic Prostate Cancer:
Documented Diagnosis: Yes
Gender Requirement: Male
Duration: 6 Month(s)
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