| Anthem Blue Cross (HMO, PPO, EPO) |
| Crysvita (burosumab-twza) |
| Hormones : Drugs for Menopause and Bone Loss |
- Quantity Limit: limit maximum 20 EA PER 90 day(s)
- Prior Authorization: Juvenile Idiopathic Arthritis:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 2
Duration: 1 year(s)
Psoriatic Arthritis (PsA), Rheumatoid Arthritis (RA):
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 1 year(s)
- Preventive Drug: Zero copay. Grand Fathered Plans at Tier 2
- PA_APPLIES
- May be covered under Medical Benefit.
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