Western Health Advantage
Afinitor Disperz (everolimus (antineoplastic))
Drugs for Cancer : Drugs for Cancer
  • Step Therapy: ST_APPLIES
  • Prior Authorization: Breast Cancer: HR+ (HER2+):
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Prior Authorization: Multiple Myeloma:
    Documented Diagnosis: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes

  • Quantity Limit: 204 lancets per 30 day(s).
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