| Anthem Blue Cross (HMO, PPO, EPO) |
| Copiktra (duvelisib) |
| Drugs for Cancer : Drugs for Cancer |
- 1;
- Quantity Limit: limit maximum 1 EA PER 1 day(s)
- Available through Specialty Pharmacy;
- Quantity Limit: limit maximum 2 EA PER 1 day(s)
- Prior Authorization: Hypoparathyroidism:
Documented Diagnosis: Yes
Medical Test Required: Yes
Age Requirement: >= 18
Duration: 6 Month(s)
Reauthorization Required: Yes
|