- Prior Authorization: Breast Cancer: HR+ (HER2+):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 1 plan year
Reauthorization Required: Yes
- Breast Cancer: HR+ (HER2+):
Age Requirement: >= 18
Duration: 1 plan year
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: Yes
Specialist Type(s): Oncologist
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
- Limited Access. Must use AcariaHealth Specialty Rx. Anti-Cancer:Maximum $200 copayment per State Law.
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