| Anthem Blue Cross - 2014 to Present (HMO, PPO, EPO) |
| Xyrem (sodium oxybate) |
| Drugs for the Nervous System : Drugs for Sleep Disorder |
- PA_APPLIES
- Complicated Urinary Tract Infections (cUTI):
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Prior Authorization: PA Applies
- Step Therapy: ST_APPLIES
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