| Anthem Blue Cross (HMO, PPO, EPO) |
| Otrexup (methotrexate (PF)) |
| Drugs for Pain and Fever : Arthritis and Pain Drugs |
- Available only through Specialty Pharmacy;
- Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
TB Test required: No
- Prior Authorization: Documented Diagnosis: Yes
Duration: 1 year(s)
- Quantity Limit: 4 auto-injector per 30 day(s).
- Step Therapy: ST Multiple Generics
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