- Prior Authorization: Breast Cancer: HR+ (HER2-):
Age Requirement: <= 19
Duration: 12 Month(s)
- Breast Cancer: HR+ (HER2-):
Age Requirement: <= 19
Duration: 12 Month(s)
- Orally administered anticancer medication.
- Quantity Limit: limit maximum 63 EA PER 28 day(s)
- Step Therapy: Breast Cancer: HR+ (HER2-):
ST Multiple Brands
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