| Anthem Blue Cross (HMO, PPO, EPO) |
| Saxenda (liraglutide (weight loss)) |
| Drugs for Eating Disorders : Drugs for Eating Disorders |
- Prior Authorization: Obesity:
Documented Diagnosis: Yes
Duration: 16 week(s)
Reauthorization Required: Yes
- Obesity:
Duration: 16 week(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
- Quantity Limit: 3 mg per 1 day(s).
|