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Xofigo
Mass General Brigham Health Plan (MCO)
Mass General Brigham Health Plan (MCO) Coverage for Xofigo
All
7
Commercial
2
Health Exchange
2
Managed Medicaid
1
Medicare
2
Commercial
Commercial - PPO
No PA
No Step Therapy
No Quantity Limit
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Commercial - HMO
No PA
No Step Therapy
No Quantity Limit
See Details
Health Exchange
Health Exchange - HMO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Health Exchange - PPO - Health Insurance Exchange
No PA
No Step Therapy
No Quantity Limit
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Managed Medicaid
Managed Medicaid - HMO - Medicaid
PA Required
No Step Therapy
No Quantity Limit
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Medicare
Medicare - Medicare Advantage Part D
No PA
No Step Therapy
No Quantity Limit
See Details
Medicare - Prescription Drug Plan
No PA
No Step Therapy
No Quantity Limit
See Details
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