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