Anthem Blue Cross (HMO, PPO, EPO)
Daraprim (pyrimethamine)
Drugs for Infections : Drugs for Parasites
  • ST_APPLIES
  • Prior Authorization: Diabetic Medical Supplies:
    Duration: 1 year(s)

  • Quantity Limit: limit maximum 80 mL PER 1 day(s)
  • QL (24 per Rx);
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