| Anthem Blue Cross (HMO, PPO, EPO) |
| abiraterone (abiraterone) |
| Drugs for Cancer : Drugs for Cancer |
- PA_APPLIES
- Diabetes Type 2: GLP1 + Combo:
Age Requirement: >= 10
Duration: 6 Month(s)
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
Supporting Documentation Requirements: 1 of Chart Notes;Lab Tests;Medication History
- Quantity Limit: Limit 15 per month;QL(0.5ea daily)
- Prior Authorization: Documented Diagnosis: Yes
Duration: 12 Month(s)
- May be covered under Medical Benefit.
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