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Vitrakvi - Larotrectinib capsule
Blue Cross and Blue Shield of Montana
Blue Cross and Blue Shield of Montana Coverage for Vitrakvi - Larotrectinib capsule
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4
Commercial
2
Health Exchange
2
Commercial
Commercial - PPO
No PA
No Step Therapy
No Quantity Limit
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Commercial - Employer
PA Required
No Step Therapy
No Quantity Limit
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Health Exchange
Health Exchange - PPO - Health Insurance Exchange
PA Required
No Step Therapy
Quantity Limit
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Health Exchange - POS - Health Insurance Exchange
PA Required
No Step Therapy
Quantity Limit
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