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
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