| Anthem Blue Cross - 2014 to Present (HMO, PPO, EPO) |
| Azelex (azelaic acid) |
| Drugs for the Skin : Drugs for the Skin |
- Prior Authorization: EDS due to OSA:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 1 year(s)
Narcolepsy Type 1, Narcolepsy Type 2:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 1 year(s)
- Anti-Cancer:Maximum $200 copayment per State Law.
- Quantity Limit: limit maximum 30 EA PER 30 day(s)
- Quantity Limit: limit maximum 30 day(s) supply
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