| Anthem Blue Cross (HMO, PPO, EPO) |
| erlotinib (erlotinib) |
| Drugs for Cancer : Drugs for Cancer |
- Step Therapy: Acromegaly:
ST Single Generic
- Prior Authorization: Hemophilia B (Factor IX):
Duration: 1 year(s)
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;- Quantity Limit: 100 grams per 30 day(s).
- Diabetic Medical Supplies:
Duration: 1 plan year
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 1 plan year
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