| Anthem Blue Cross (HMO, PPO, EPO) |
| Enhertu (fam-trastuzumab deruxtecn-nxki) |
| Drugs for Cancer : Drugs for Cancer |
- Quantity Limit: 204 lancets per 30 day(s).
- Minimum Age: 18 Years; Maximum Age: N.A.;
- Prior Authorization: Severe Primary Insulin-like Growth Factor Deficiency (IGFD):
Documented Diagnosis: Yes
Medical Test Required: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
- Prior Authorization: Rheumatoid Arthritis (RA):
Documented Diagnosis: Yes
Duration: 12 Month(s)
Reauthorization Required: Yes
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