Anthem Blue Cross (HMO, PPO, EPO)
Follistim AQ (Soln) (follitropin beta)
Hormones : Drugs for Women
  • Quantity Limit: 30 day supply per 1 fill(s).
  • PA Applies
  • Prior Authorization: Diabetic Medical Supplies:
    Documented Diagnosis: Yes
    Duration: 1 plan year
    Reauthorization Required: Yes