| Anthem Blue Cross - 2014 to Present (HMO, PPO, EPO) |
| Maxalt-MLT (rizatriptan) |
| Drugs for the Nervous System : Drugs for Migraine Headaches |
- ST_APPLIES
- Prior Authorization: Hereditary Angioedema (HAE):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 1 plan year
Reauthorization Required: Yes
|