Sancuso — Blue Cross Blue Shield of Alabama

Initial criteria

• Quantities above the program set limit for Sancuso will be approved when ONE of the following is met:
• • The patient has cancer chemotherapy related nausea and vomiting and will be receiving chemotherapy more than 14 days per month OR
• • The prescriber has provided information supporting the use of the requested agent for the requested diagnosis and quantity

Approval duration

12 months