| Anthem Blue Cross (HMO, PPO, EPO) |
| Oxbryta (voxelotor) |
| Drugs for the Blood : Drugs for the Blood |
- Available only through Specialty Pharmacy;
For FAX form click HERE
Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
Log in to Surescripts
Log in to CoverMyMeds; For details on drug coverage click HERE; Split Fill;
- PA Applies
- Quantity Limit: 5 tablets per 1 day(s).
- Sickle Cell Disease:
Age Requirement: >= 12
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
- Prior Authorization: Sickle Cell Disease:
Documented Diagnosis: Yes
Age Requirement: >= 12
Duration: 1 year(s)
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