UnitedHealthcare
Pemazyre (pemigatinib)
Drugs for Cancer : Drugs for Cancer
  • Quantity Limit: Maximum quantity 14 tablets per 21 day
  • Prior Authorization: Cholangiocarcinoma:
    Documented Diagnosis: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes

  • Cholangiocarcinoma:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)