| Anthem Blue Cross - 2014 to Present (HMO, PPO, EPO) |
| Provigil (modafinil) |
| Drugs for the Nervous System : Drugs for Sleep Disorder |
- Chronic Heart Failure (CHF):
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: Unspecified
- Zero copay may apply.
- Step Therapy: Cluster Seizure/Seizure Emergency:
ST Multiple Generics
- Quantity Limit: limit maximum 30 day(s) supply
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