| Anthem Blue Cross (HMO, PPO, EPO) |
| Nuzyra (omadacycline) |
| Drugs for Infections : Antibiotics |
- Step Therapy Applies
- Quantity Limit: 1 tablet per 1 day(s).
- Prior Authorization: Community Acquired Bacterial Pneumonia:
Duration: 1 year(s)
- Community Acquired Bacterial Pneumonia:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
|