Anthem Blue Cross (HMO, PPO, EPO)
Pulmozyme (dornase alfa)
Drugs for the Lungs : Drugs for the Lungs
  • Prior Authorization: PA_APPLIES
  • PA Applies
  • QL (30 per Rx);
  • Step Therapy: ST_APPLIES
  • PA Required
  • Quantity Limit: limit maximum 120 EA PER 30 day(s)
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