| Anthem Blue Cross (HMO, PPO, EPO) |
| Gimoti (metoclopramide HCl) |
| Drugs for the Stomach : Drugs for the Stomach |
- Prior Authorization: Diabetic Gastroparesis:
Duration: 1 year(s)
- Diabetic Gastroparesis:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Quantity Limit: 1 bottle per 4 weeks(s).
- Step Therapy: Diabetic Gastroparesis:
ST Single Generic
|