Anthem Blue Cross (HMO, PPO, EPO) |
FazaClo (clozapine) |
Drugs for the Nervous System : Drugs for Severe Mental Disorders |
- Quantity Limit: 9 tablets per 1 day(s).
- Step Therapy: Psychiatry: Schizophrenia:
ST Single Generic
- Psychiatry: Schizophrenia:
Age Requirement: > 17
Duration: 12 Month(s)
Medical Test Required: No
Reauthorization Required: No
Policy Requires Documentation of Patient Noncompliance to Oral Therapy: No
Established tolerability to oral formulation: No
Documented Diagnosis: No
- Prior Authorization: Psychiatry: Schizophrenia:
Age Requirement: > 17
Duration: 12 Month(s)
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