Anthem Blue Cross - 2014 to Present (HMO, PPO, EPO)
Zomacton (somatropin)
Hormones : Drugs for Growth
  • Prior Authorization: Bipolar:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 1 year(s)

    Psychiatry: Schizophrenia:
    Age Requirement: > 17
    Duration: 12 Month(s)

  • Prior Authorization: Breast Cancer: HR+ (HER2-):
    Age Requirement: >= 18
    Duration: 12 Month(s)

  • May be covered under Medical Benefit.
  • Prior Authorization: Peanut Allergy:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 4
    Duration: 1 year(s)
    Reauthorization Required: Yes

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