Anthem Blue Cross - 2014 to Present (HMO, PPO, EPO) |
Keveyis (dichlorphenamide) |
Drugs for Muscles, Ligaments, Tendons, and Bones : Drugs for Muscles, Ligaments, Tendons, and Bones |
- PA_APPLIES
- Prior Authorization: Documented Diagnosis: Yes
Duration: 12 Month(s)
- Osteoarthritis: OA of the Knee:
Duration: 6 Month(s)
Specialist Required: Yes
Documented Diagnosis: Yes
Medical Test Required: No
Specialist Type(s): 1 of Orthopedic Specialist;Rheumatologist;Sports Medicine Specialist
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
Elapsed Duration Since Previous Course of Therapy: 6 month(s)
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