| Anthem Blue Cross (HMO, PPO, EPO) |
| Nesina (alogliptin) |
| Hormones : Drugs for Diabetes |
- Prior Authorization: Diabetes Type 2: DPP4 + Combo:
Documented Diagnosis: Yes
Duration: 1 year(s)
- Quantity Limit: 1 tablet per 1 day(s).
- Step Therapy: Diabetes Type 2: DPP4 + Combo:
ST Generic and Brand
- Diabetes Type 2: DPP4 + Combo:
Duration: 1 year(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: No
Duration of Reauthorization: N/A
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