Xofigo® (radium-223 dichloride)5

No prior authorization required for:

  • Emergency room
  • Inpatient
  • Skilled nursing facility

For further information, please see the Injectable Drugs page

Code(s): A9606

Benefit: Medical

Notes: Treatment of metastatic prostate cancer

Criteria for coverage:

  • No PA for Commercial

  • Not Covered for Medicare Part D