Anthem Blue Cross (HMO, PPO, EPO)
Synagis (palivizumab)
Biological Agents : Biological Agents
  • Respiratory Syncytial Virus (RSV):
    Duration: 5 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

  • Prior Authorization: Respiratory Syncytial Virus (RSV):
    Documented Diagnosis: Yes
    Duration: 5 Month(s)

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