New PDL Criteria Check Stage-Four Advance Metastatic Cancer Diagnosis

New PDL Criteria Check Stage-Four Advance Metastatic Cancer Diagnosis

FirstCare added a new exception criteria to the Jan. 24 preferred drug list, to check for a diagnosis of stage-four advanced metastatic cancer, or for treatment of symptoms associated with the cancer diagnosis. Prescribers must contact the pharmacy prior authorization call center and attest the person meets the exception criteria for the non-preferred drug to be approved because diagnoses are not readily available in a person’s medical claims data. All clinical edit criteria can be found here.

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