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
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