Anthem Blue Cross (HMO, PPO, EPO)
Acthar (corticotropin)
Hormones : Hormones
  • Step Therapy: ST Multiple Generics

  • Prior Authorization: Adjunctive Rheumatoid Arthritis, Nephrotic Syndrome:
    Documented Diagnosis: Yes
    Duration: 1 year(s)

    Multiple Sclerosis Exacerbation:
    Duration: 1 year(s)

  • Adjunctive Rheumatoid Arthritis, Nephrotic Syndrome:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

    Multiple Sclerosis Exacerbation:
    Duration: 1 year(s)
    Documented Diagnosis: No
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

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