Sutter Health Plus
Lenvima (14 MG Daily Dose) (lenvatinib)
Drugs for Cancer : Drugs for Cancer
  • Anti-Cancer:Maximum $200 copayment per State Law. Must use AcariaHealth Specialty Rx.
  • Anti-Cancer: Maximum $200 copayment per State Law. Must use AcariaHealth Specialty Rx.
  • Psoriasis (PsO):
    Duration: 1 year(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Dermatologist;Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 year(s)
    TB Test required: No
    History of Plaque Psoriasis: N/A
    Overall % of Body Surface For Initiation: N/A
    Overall % of Body Surface For Initiation With Sensitive Areas: N/A
    Psoriasis Classification: moderate to severe
    Sensitive Area BSA Percent override: No

    Psoriatic Arthritis (PsA):
    Duration: 1 year(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Dermatologist;Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 year(s)
    TB Test required: No

  • Prior Authorization: Growth Hormone Deficiency:
    Documented Diagnosis: Yes
    Duration: 6 Month(s)
    Reauthorization Required: Yes