- Quantity Limit: 4 capsule per 1 day(s).
- Prior Authorization: Gastrointestinal Stromal Tumor, Kidney Cancer, Neuroendocrine Tumor (NET), Soft Tissue Sarcoma:
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
Thyroid Carcinoma:
Duration: 12 Month(s)
- Quantity Limit: 8 tablets per 1 day(s).
- Prior Authorization: Paroxysmal Nocturnal Hemoglobinuria:
Documented Diagnosis: Yes
Duration: 6 Month(s)
Reauthorization Required: Yes
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