- Step Therapy: Breast Cancer: HR+ (HER2-):
ST Single Generic
Colorectal Cancer:
ST Multiple Generics
- Prior Authorization: Breast Cancer: HR+ (HER2-), Colorectal Cancer:
Duration: 1 year(s)
Breast Cancer: Triple Negative, Esophageal Cancer:
Documented Diagnosis: Yes
Duration: 1 year(s)
- Available only through Specialty Pharmacy; May process through Pharmacy or Medical benefit depending on Patient location;
For FAX form click HERE
Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
Log in to Surescripts
Log in to CoverMyMeds; For details on drug coverage click HERE;
- Breast Cancer: HR+ (HER2-):
Duration: 1 year(s)
Breast Cancer: Triple Negative, Esophageal Cancer:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Colorectal Cancer:
Duration: 1 year(s)
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
Documented Diagnosis: No
Specialty Pharmacy is Required: Not Defined
- PA Applies
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