| Anthem Blue Cross - 2014 to Present (HMO, PPO, EPO) |
| Koate-DVI (antihemophilic factor) |
| Drugs for the Blood : Drugs to Prevent Bleeding |
- Quantity Limit: 1 bottle per 30 day(s).
- Step Therapy: Psychiatry: Schizophrenia:
ST Multiple Generics
- ST_APPLIES
- Prior Authorization: Documented Diagnosis: Yes
Age Requirement: >= 12
Duration: 12 Month(s)
Reauthorization Required: Yes
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