Anthem Blue Cross (HMO, PPO, EPO) |
Dacogen (decitabine) |
Drugs for Cancer : Drugs for Cancer |
- Quantity Limit: limit maximum 3 EA PER fill retail
- Aggressive Systemic Mastocytosis (ASM):
Age Requirement: >= 18
Duration: 12 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): 1 of Allergist;Immunologist;Oncologist
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
Gastrointestinal Stromal Tumor: 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: = 1 plan year
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