Anthem Blue Cross - 2014 to Present (HMO, PPO, EPO)
Elidel (pimecrolimus)
Drugs for the Skin : Drugs for the Skin
  • ST_APPLIES
  • Prior Authorization: Immune Thrombocytopenic Purpura (ITP):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Duration: 1 year(s)

  • Quantity Limit: 4 tablets per 1 day(s).
  • Gaucher Disease:
    Age Requirement: >= 4
    Duration: 6 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: >= 6 month(s)

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