- Prior Authorization: RET-Fusion Non-Small Cell Lung Cancer:
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
RET-Fusion Thyroid Cancer, RET-Mutant MTC:
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
- RET-Fusion Non-Small Cell Lung Cancer:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
RET-Fusion Thyroid Cancer, RET-Mutant MTC:
Duration: 12 Month(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
- Quantity Limit: Maximum quantity of 124 per 31 Day(s). Maximum quantity 4 capsules per day.
- Orally administered anticancer medication.
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