| Anthem Blue Cross - 2014 to Present (HMO, PPO, EPO) |
| Kalydeco (ivacaftor) |
| Drugs for the Lungs : Drugs for Cystic Fibrosis |
- PA_APPLIES
- Prior Authorization: Gastro: IBS-D:
Duration: 14 Day(s)
- Orally administered anticancer medication.
- Quantity Limit: limit maximum 30 EA PER 25 day(s)
- Prior Authorization: Colorectal Cancer, Gastrointestinal Stromal Tumor, Soft Tissue Sarcoma:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 1 plan year
Reauthorization Required: Yes
Hepatocellular Carcinoma:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 12 Month(s)
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