| Anthem Blue Cross (HMO, PPO, EPO) |
| Lyumjev KwikPen (insulin lispro-aabc) |
| Hormones : Drugs for Diabetes |
- Step Therapy: ST_APPLIES
- Prior Authorization: Diabetic Medical Supplies:
Documented Diagnosis: Yes
Duration: 1 plan year
Reauthorization Required: Yes
- Quantity Limit: limit maximum 1 EA PER 1 day(s)
- Quantity Limit: limit maximum 30 day(s) supply
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