| Anthem Blue Cross - 2014 to Present (HMO, PPO, EPO) |
| Zypitamag (pitavastatin magnesium) |
| Drugs for the Heart : Drugs for Cholesterol |
- ST_APPLIES
- Prior Authorization: Antiviral: Hepatitis C (HCV):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 24 week(s)
Reauthorization Required: Yes
|