| Anthem Blue Cross (HMO, PPO, EPO) |
| Trelstar 22.5 Mg/2 Ml Syrg (triptorelin pamoate) |
| Drugs for Cancer : Drugs for Cancer |
- Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Prior Authorization: Documented Diagnosis: Yes
|