| Anthem Blue Cross (HMO, PPO, EPO) |
| Daklinza (daclatasvir) |
| Drugs for Infections : Drugs for Viral Infections |
- Quantity Limit: 30 day supply per 1 fill(s).
- Prior Authorization: Multiple Sclerosis (MS):
Documented Diagnosis: Yes
Duration: 1 year(s)
- Quantity Limit: 30 day supply per 1 fill(s).
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