| Anthem Blue Cross - 2014 to Present (HMO, PPO, EPO) |
| Sunosi (solriamfetol) |
| Drugs for the Nervous System : Drugs for Sleep Disorder |
- Prior Authorization: Breast Cancer: HR+ (HER2+):
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
- QL (2 per Rx);
- Quantity Limit: 204 strips per 30 day(s).
- Quantity Limit: limit maximum 30 day(s) supply
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