| Anthem Blue Cross (HMO, PPO, EPO) |
| ALPRAZolam Intensol (alprazolam) |
| Drugs for the Nervous System : Drugs for Anxiety |
- Quantity Limit: limit maximum 4 mL PER 1 day(s)
- Prior Authorization: Anxiety:
Duration: 1 year(s)
- Step Therapy: Anxiety:
ST Multiple Generics
- Anxiety:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
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