Anthem Blue Cross (HMO, PPO, EPO) |
Mvasi (Intravenous Soln) (Bevacizumab-Awwb) |
Drugs for Cancer : Drugs for Cancer |
For FAX form click HERE Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites: Log in to Surescripts Log in to CoverMyMeds; For details on drug coverage click HERE;
- Derm: Acne Vulgaris:
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: Unspecified
Limited to non-cosmetic use: No
Supporting Documentation Requirements: Chart Notes
- ST_APPLIES
- Step Therapy: Cytomegalovirus (CMV):
ST Single Generic
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