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05/18/2016 Prior Authorization MERCY MARICOPA INTEGRATED CARE - TXIX/XXI SMI MEDICAID AZ88 This fax machine is located in a secure location as required by HIPAA regulations. Cancer NSCLC 5. Is requested for treatment of metastatic NSCLC that is positive for a sensitizing EGFR mutation i.e. exon 19 deletions or exon 21 L858R substitution If yes please list type of mutation or submit records. Is prescribed by or in consultation with an oncologist 12. Is the patient also taking a proton-pump...
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