Anthem Blue Cross (HMO, PPO, EPO)
glipizide (glipizide)
Hormones : Drugs for Diabetes
  • Quantity Limit: 2 tablets per 1 day(s).
  • PA_APPLIES
  • PA**;
  • Prior Authorization: Adult Onset Stills Disease (AOSD), Rheumatoid Arthritis (RA):
    Documented Diagnosis: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes

    Cryopyrin-Associated Periodic Syndromes (CAPS):
    Duration: 12 Month(s)
    Reauthorization Required: Yes

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