- Prior Authorization: NSCLC ALK+ OR ROS1+ Disease:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 12 Month(s)
Reauthorization Required: Yes
- NSCLC ALK+ OR ROS1+ Disease:
Age Requirement: >= 18
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): Oncologist
Reauthorization Required: Yes
Duration of Reauthorization: = 12 month(s)
- Anti-Cancer: Maximum $200 copayment per State Law.
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