Ibrance — Medical Mutual
Well-Differentiated/Dedifferentiated Liposarcoma (WD-DDLS)
Preferred products
- Verzenio
- Kisqali
- Kisqali Femara Co-Pack
Initial criteria
- Prescribed by or in consultation with a hematologist or oncologist
- Ibrance will be used as a single agent
- The patient has unresectable disease of the retroperitoneum
Approval duration
1 year initial, 1 year reauth