| Anthem Blue Cross (HMO, PPO, EPO) |
| Tibsovo (ivosidenib) |
| Drugs for Cancer : Drugs for Cancer |
- Minimum Age: 6 Years; Maximum Age: N.A.;
- Quantity Limit: limit maximum 60 EA PER 30 day(s)
- Step Therapy: ST_APPLIES
- Quantity Limit: 1 tablet per 1 day(s).
- Quantity Limit: 204 lancets per 30 day(s).
- Derm: Rosacea:
Duration: 1 year(s)
Documented Diagnosis: No
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
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