Anthem Blue Cross (HMO, PPO, EPO)
teriparatide (teriparatide)
Hormones : Drugs for Menopause and Bone Loss
  • Step Therapy: Ankylosing Spondylitis (AS), Crohn's Disease (CD), Psoriasis (PsO), Psoriatic Arthritis (PsA), Rheumatoid Arthritis (RA):
    ST Multiple Brands

    Nonradiographic Axial Spondyloarthritis:
    ST Multiple Generics

  • Quantity Limit: 5 capsules per 25 day(s).
  • Hidradenitis Suppurativa (HS):
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 24 month(s)

    Psoriasis (PsO):
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 24 month(s)
    TB Test required: No
    History of Plaque Psoriasis: N/A
    Overall % of Body Surface For Initiation: N/A
    Overall % of Body Surface For Initiation With Sensitive Areas: N/A
    Psoriasis Classification: Moderate-Severe
    Sensitive Area BSA Percent override: No

    Uveitis:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialty Pharmacy Provider(s): 1 of AllCare Plus Pharmacy;BriovaRx
    Reauthorization Required: No
    Duration of Reauthorization: N/A

  • Quantity Limit: limit maximum 1 EA PER 1 day(s)