Covered Uses: | All FDA approved indications not otherwise excluded from Part D. Additional coverage for off-label uses include Crohn's disease, aphthous ulcers in the presence of HIV or AIDS, prostate cancer, malignant melanoma, myelofibrosis, myelodysplastic syndromes, and advanced hepatocellular carcinoma. |
Exclusion Criteria: | |
Required Medical Information: | |
Age Restrictions: | |
Prescriber Restrictions: | |
Coverage Duration: | 12 months |
Other Criteria: |