Sutter Health Plus
Iclusig (ponatinib)
Drugs for Cancer : Drugs for Cancer
  • Quantity Limit: limit maximum 3 EA PER fill retail
  • High Risk Medications require PA for members age 70 and older
  • Prior Authorization: Lambert-Eaton Myasthenic Syndrome (LEMS):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Duration: 3 Month(s)