This policy will apply to
all services performed on or after the above revision date which will become the
new effective date.
For all services referred
to in this policy that were performed before the revision date, contact customer
service for the rules that would apply.
requires prior authorization.
Brukinsa is used to treat
mantle cell lymphoma (MCL).
Brukinsa is an oral
specialty drug and must be obtained through a contracted specialty pharmacy.