Anthem Blue Cross (HMO, PPO, EPO)
Uplizna (inebilizumab-cdon)
Drugs for the Eye : Drugs for the Eye
  • Prior Authorization: Neuromyelitis Optica Spectrum Disorder:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 18
    Duration: 1 year(s)
    Reauthorization Required: Yes


  • For FAX form click HERE
    Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
     Log in to Surescripts
     Log in to CoverMyMeds; For details on drug coverage click  HERE;
  • PA Applies
  • Neuromyelitis Optica Spectrum Disorder:
    Age Requirement: >= 18
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 year(s)

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