Health Net
Cotellic (cobimetinib)
Drugs for Cancer : Drugs for Cancer
  • Prior Authorization: Melanoma (MEL):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 18
    Duration: 1 plan year
    Reauthorization Required: Yes

  • Anti-Cancer:Maximum $200 copayment per State Law. Must use AcariaHealth Specialty Rx.
  • Melanoma (MEL):
    Age Requirement: >= 18
    Duration: 1 plan year
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): 1 of Oncologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 plan year