Sutent Prior Authorization Form
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Prior Authorization Program Information*
www.floridablue.com**refer to member’s individual policy for inclusion in the prior authorization program Florida Blue is an Independent Licensee of the Blue Cross and Blue Shield Association Prior Authorization Program Information* Current 7/1/2015 *Please note that Prior Authorization requirements may vary and member benefits and contract will prevail.
Prior Authorization Program Information
www.bcbsfl.comPrior Authorization Program Information Current 10/1/21 . Newly marketed prescription medications may not be covered until the Pharmacy & Therapeutics Committee has had an opportunity to review the medication to determine if the medication will be covered and if so, which tier will apply based on safety, efficacy, and the
Prior Authorization Program Information
www.bcbsfl.comPrior Authorization Program Information Current 1/1/22 . Newly marketed prescription medications may not be covered until the Pharmacy & Therapeutics Committee has had an opportunity to review the medication to determine if the medication will be covered and if so, which tier will apply based on safety, efficacy, and the