Anthem Blue Cross (HMO, PPO, EPO)
Piqray (250 MG Daily Dose) (alpelisib)
Drugs for Cancer : Drugs for Cancer
  • Prior Authorization: Diabetes Type 2: GLP1 + Combo:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • PA_APPLIES
  • QL (60 per Rx);
  • Prior Authorization: PA Required
  • Step Therapy: ST_APPLIES