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)
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