Does 15983pa0030004 cover mitomycin?
15983pa0030004
15983-15983PA0030004-0 · ACA · ACA Marketplace
mitomycin
mitomycinunder 15983pa0030004
Covered — requires prior authorization
Your plan has to approve it first — your doctor’s office handles it.
What you'd pay
This plan doesn't publish a price for this tier. Your pharmacy can quote it before you fill.
Amount limit applies — you can still fill it, but your plan caps how much you get at a time. This plan's drug list records the cap without stating the amount — your pharmacy can tell you when they fill it.
- Tier
- Non preferred generic non preferred brand
- Approval first
- Required
- Try another first
- No
- Amount limit
- Yes
Talk to your pharmacist or doctor before acting on anything here. They can see your full history and this page cannot. Never start, stop, or switch a medication based on it. Coverage rules change and plans make exceptions — your pharmacy can check your exact benefit in seconds.As of Sep 14, 2026 · CMS QHP machine-readable. Reference information, not medical advice and not a price.
Covered forms and strengths (2)
- mitomycin 20 MG InjectionApproval firstAmount limit
- mitomycin 20 MG Injection [Mutamycin]Approval firstAmount limit