Health Net
Kisqali (200 MG Dose) (ribociclib)
Drugs for Cancer : Drugs for Cancer
  • Hemophilia A (Factor VIII):
    Duration: 1 year(s)
    Documented Diagnosis: No
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Dosing Limit(s): N/A
    Treatment Center Required: No

    Von Willebrand Disease:
    Duration: 1 year(s)
    Documented Diagnosis: No
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Dosing Limit(s): N/A
    Treatment Center Required: No
    Dosing Limits Exist: No

  • QL (300 per Rx);
  • Quantity Limit: Limit 528gms per month;QL(17.6 gm daily)